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Ostomy Pouch, Urinary, for Use on Faceplate, Rubber

South Carolina rates for HCPCS A4383

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

Rates data updated July 2026.

Facilitymedian $32 · 10th–90th $17$540%20%10th90th$32Professionalmedian $30 · 10th–90th $17$350%20%40%10th90th$30$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
$31.62
Median
$31.62
Typical High
$31.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$17.78
Median
$31.62
Typical High
$34.67
BCBS
Setting
Facility
Modifier
Global
Typical Low
$25.70
Median
$36.31
Typical High
$39.81
BCBS
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$39.81
Typical High
$50.12
Cigna
Setting
Facility
Modifier
Global
Typical Low
$21.88
Median
$26.30
Typical High
$26.92
Cigna
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$22.39
Typical High
$26.92
Medcost
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$25.12
Medcost
Setting
Facility
Modifier
Global
Typical Low
$22.39
Median
$36.31
Typical High
$64.57
Medcost
Setting
Professional
Modifier
Global
Typical Low
$10.72
Median
$10.72
Typical High
$13.18
Molina
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$26.92
United
Setting
Facility
Modifier
Global
Typical Low
$12.59
Median
$15.49
Typical High
$39.81
United
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$18.62
Typical High
$25.12