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Ostomy Pouch, Urinary, for Use on Faceplate, Rubber

Ohio rates for HCPCS A4383

Ostomy pouch, urinary, for use on faceplate, rubber, each

Rates data updated July 2026.

Facilitymedian $28 · 10th–90th $16$420%20%10th90th$28Professionalmedian $24 · 10th–90th $16$420%10%20%10th90th$24$0.5$2.0$10.0$50.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$25.12
Median
$33.11
Typical High
$41.69
Aetna
Setting
Professional
Modifier
Global
Typical Low
$20.89
Median
$25.12
Typical High
$33.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$23.99
Typical High
$52.48
CareSource
Setting
Facility
Modifier
Global
Typical Low
$19.50
Median
$33.11
Typical High
$46.77
CareSource
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$35.48
Typical High
$53.70
Cigna
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$26.30
Typical High
$28.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$22.39
Typical High
$22.39
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$26.30
Typical High
$27.54
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$22.39
Typical High
$22.39
Molina
Setting
Professional
Modifier
Global
Typical Low
$20.89
Median
$29.51
Typical High
$40.74
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$44.67
Typical High
$83.18
United
Setting
Facility
Modifier
Global
Typical Low
$12.59
Median
$17.78
Typical High
$39.81
United
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$18.62
Typical High
$27.54