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Ostomy Pouch, Urinary, for Use on Faceplate, Plastic

Montana rates for HCPCS A4381

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

Rates data updated July 2026.

Facilitymedian $6 · 10th–90th $4$80%20%40%10th90th$6Professionalmedian $5 · 10th–90th $2$280%20%10th90th$5$2.0$5.0$10.0$20.0$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
Professional
Modifier
Global
Typical Low
$1.78
Median
$5.13
Typical High
$28.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.89
Median
$6.76
Typical High
$6.76
Cigna
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$6.76
Typical High
$6.76
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$5.01
Median
$6.31
Typical High
$12.30
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$6.31
Typical High
$12.30
Providence
Setting
Facility
Modifier
Global
Typical Low
$3.16
Median
$6.03
Typical High
$7.76
Providence
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$6.76
Typical High
$79.43
United
Setting
Facility
Modifier
Global
Typical Low
$2.19
Median
$2.51
Typical High
$2.51
United
Setting
Professional
Modifier
Global
Typical Low
$2.45
Median
$2.75
Typical High
$3.72