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Ostomy Pouch, Urinary, for Use on Faceplate, Rubber

Pennsylvania rates for HCPCS A4383

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

Rates data updated July 2026.

Facilitymedian $55 · 10th–90th $19$2090%20%10th90th$55Professionalmedian $24 · 10th–90th $17$400%20%10th90th$24$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$19.50
Median
$19.50
Typical High
$30.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$23.99
Typical High
$37.15
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$26.30
Typical High
$54.95
Cigna
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$22.39
Typical High
$22.39
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$52.48
Typical High
$75.86
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$23.99
Median
$28.18
Typical High
$39.81
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$19.50
Median
$19.50
Typical High
$30.90
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$19.50
Median
$23.99
Typical High
$32.36
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$20.89
Median
$20.89
Typical High
$20.89
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$144.54
Typical High
$229.09
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$37.15
Typical High
$37.15
United
Setting
Facility
Modifier
Global
Typical Low
$13.18
Median
$17.78
Typical High
$25.12
United
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$19.50
Typical High
$42.66