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Ostomy Pouch, Urinary, for Use on Faceplate, Rubber

Virginia rates for HCPCS A4383

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

Rates data updated July 2026.

Facilitymedian $31 · 10th–90th $23$650%20%10th90th$31Professionalmedian $25 · 10th–90th $17$370%20%40%10th90th$25$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$24.55
Median
$24.55
Typical High
$26.92
Aetna
Setting
Professional
Modifier
Global
Typical Low
$16.98
Median
$24.55
Typical High
$29.51
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$40.74
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$27.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$26.30
Typical High
$26.92
Cigna
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$22.39
Typical High
$22.39
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$39.81
Typical High
$56.23
Medcost
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$28.18
Typical High
$42.66
Medcost
Setting
Facility
Modifier
Global
Typical Low
$16.22
Median
$28.84
Typical High
$47.86
Medcost
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$24.55
Typical High
$26.30
Sentara
Setting
Facility
Modifier
Global
Typical Low
$26.92
Median
$34.67
Typical High
$114.82
Sentara
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$34.67
Typical High
$114.82
United
Setting
Facility
Modifier
Global
Typical Low
$11.22
Median
$15.14
Typical High
$19.95
United
Setting
Professional
Modifier
Global
Typical Low
$16.60
Median
$19.50
Typical High
$30.90