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Ostomy Pouch, Urinary, for Use on Faceplate, Plastic

New York rates for HCPCS A4381

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

Rates data updated July 2026.

Facilitymedian $4 · 10th–90th $3$90%20%10th90th$4Professionalmedian $4 · 10th–90th $3$90%20%10th90th$4$0.1$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$2.82
Median
$3.98
Typical High
$7.41
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.69
Median
$3.98
Typical High
$6.17
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.24
Median
$3.24
Typical High
$10.47
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$5.01
Median
$5.37
Typical High
$5.37
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$5.37
Median
$5.37
Typical High
$5.37
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.89
Median
$3.89
Typical High
$8.91
Cigna
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$3.31
Typical High
$4.57
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$10.96
Typical High
$25.12
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$4.17
Median
$6.92
Typical High
$12.59
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$3.55
Median
$3.55
Typical High
$3.72
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.55
Median
$4.68
Typical High
$4.68
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$7.76
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$6.31
Typical High
$7.41
United
Setting
Facility
Modifier
Global
Typical Low
$2.24
Median
$2.75
Typical High
$18.20
United
Setting
Professional
Modifier
Global
Typical Low
$2.29
Median
$4.27
Typical High
$10.96
Univera
Setting
Facility
Modifier
Global
Typical Low
$3.55
Median
$4.57
Typical High
$4.68
Univera
Setting
Professional
Modifier
Global
Typical Low
$3.55
Median
$4.68
Typical High
$4.68