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Ostomy Pouch, Urinary, for Use on Faceplate, Plastic

New Hampshire rates for HCPCS A4381

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

Rates data updated July 2026.

Facilitymedian $3 · 10th–90th $3$40%50%10th90th$3Professionalmedian $4 · 10th–90th $3$60%20%10th90th$4$2.0$5.0$10.0$20.0

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
$3.39
Median
$3.39
Typical High
$4.07
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.82
Median
$3.39
Typical High
$4.07
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.24
Median
$3.24
Typical High
$3.24
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.89
Median
$3.89
Typical High
$5.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$3.31
Typical High
$3.98
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$5.62
Median
$5.62
Typical High
$10.47
United
Setting
Facility
Modifier
Global
Typical Low
$1.70
Median
$2.51
Typical High
$2.69
United
Setting
Professional
Modifier
Global
Typical Low
$2.24
Median
$3.72
Typical High
$5.62
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$8.51
Median
$8.51
Typical High
$12.88