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Ostomy Pouch, Urinary, for Use on Faceplate, Plastic

Wisconsin rates for HCPCS A4381

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

Rates data updated July 2026.

Facilitymedian $7 · 10th–90th $5$120%20%40%10th90th$7Professionalmedian $6 · 10th–90th $3$110%10%20%10th90th$6$2.0$5.0$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
Facility
Modifier
Global
Typical Low
$3.72
Median
$3.72
Typical High
$3.72
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.72
Median
$3.72
Typical High
$5.62
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$10.96
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.17
Median
$6.17
Typical High
$7.24
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.89
Median
$20.42
Typical High
$33.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$9.55
Typical High
$12.59
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$3.63
Median
$5.62
Typical High
$9.33
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$13.18
Typical High
$16.22
Medica
Setting
Facility
Modifier
Global
Typical Low
$3.72
Median
$6.46
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$2.75
Median
$3.24
Typical High
$7.08
Molina
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$33.11
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$10.47
Median
$10.47
Typical High
$10.47
Network Health
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$7.41
Typical High
$12.88
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$3.63
Median
$5.62
Typical High
$9.33
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$3.72
Median
$3.72
Typical High
$6.46
Quartz
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$10.00
Typical High
$16.22
Quartz
Setting
Facility
Modifier
Global
Typical Low
$3.89
Median
$13.49
Typical High
$79.43
Quartz
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$9.77
Typical High
$33.11
Security Health
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$6.61
Security Health
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$6.61
United
Setting
Facility
Modifier
Global
Typical Low
$2.09
Median
$2.95
Typical High
$6.61
United
Setting
Professional
Modifier
Global
Typical Low
$2.14
Median
$3.24
Typical High
$5.50