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Ostomy Pouch, Urinary, for Use on Faceplate, Rubber

Washington rates for HCPCS A4383

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

Rates data updated July 2026.

Facilitymedian $39 · 10th–90th $22$760%20%10th90th$39Professionalmedian $32 · 10th–90th $16$660%10%10th90th$32$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
$22.39
Median
$22.39
Typical High
$52.48
Aetna
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$22.39
Typical High
$169.82
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$33.88
Typical High
$33.88
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$33.88
Typical High
$44.67
Cigna
Setting
Facility
Modifier
Global
Typical Low
$25.12
Median
$26.30
Typical High
$26.30
Cigna
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$22.39
Typical High
$22.39
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$23.44
Median
$43.65
Typical High
$85.11
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$50.12
Typical High
$81.28
Molina
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$30.20
Typical High
$64.57
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$35.48
Median
$38.90
Typical High
$39.81
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$39.81
Typical High
$39.81
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$32.36
Median
$34.67
Typical High
$63.10
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$38.90
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.88
Typical High
$44.67
United
Setting
Facility
Modifier
Global
Typical Low
$15.14
Median
$16.60
Typical High
$22.39
United
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$18.20
Typical High
$32.36
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$33.88
Typical High
$60.26