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Ostomy Pouch, Urinary, for Use on Faceplate, Rubber

Michigan rates for HCPCS A4383

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

Rates data updated July 2026.

Facilitymedian $52 · 10th–90th $19$1820%10%20%10th90th$52Professionalmedian $30 · 10th–90th $18$400%10%20%10th90th$30$0.5$2.0$10.0$50.0$200.0

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
$30.20
Median
$30.20
Typical High
$30.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$25.12
Typical High
$33.88
BCBS
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$117.49
Typical High
$229.09
BCBS
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$40.74
CareSource
Setting
Facility
Modifier
Global
Typical Low
$25.70
Median
$25.70
Typical High
$25.70
Cigna
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$26.30
Typical High
$26.92
Cigna
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$24.55
Typical High
$26.30
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$74.13
Typical High
$83.18
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$32.36
Typical High
$47.86
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$24.55
Typical High
$32.36
United
Setting
Facility
Modifier
Global
Typical Low
$10.72
Median
$15.14
Typical High
$25.12
United
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$18.62
Typical High
$28.18