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Ostomy Pouch, Urinary, with Faceplate Attached, Plastic

Montana rates for HCPCS A4379

Ostomy pouch, urinary, with faceplate attached, plastic, each

Rates data updated July 2026.

Facilitymedian $20 · 10th–90th $14$260%20%40%10th90th$20Professionalmedian $17 · 10th–90th $6$790%10%10th90th$17$10.0$20.0$50.0$100.0

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
Professional
Modifier
Global
Typical Low
$5.75
Median
$16.60
Typical High
$91.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$21.88
Typical High
$21.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$17.78
Typical High
$21.88
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$16.22
Median
$20.42
Typical High
$39.81
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$20.42
Typical High
$39.81
Providence
Setting
Facility
Modifier
Global
Typical Low
$10.23
Median
$19.50
Typical High
$25.12
Providence
Setting
Professional
Modifier
Global
Typical Low
$14.79
Median
$21.88
Typical High
$79.43
United
Setting
Facility
Modifier
Global
Typical Low
$7.08
Median
$8.13
Typical High
$8.13
United
Setting
Professional
Modifier
Global
Typical Low
$7.94
Median
$8.91
Typical High
$12.02