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Ostomy Pouch, Urinary, for Use on Faceplate, Rubber

Minnesota rates for HCPCS A4383

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

Rates data updated July 2026.

Facilitymedian $117 · 10th–90th $26$3240%10%10th90th$117Professionalmedian $40 · 10th–90th $25$460%50%10th90th$40$0.1$0.2$1.0$5.0$20.0$100.0$500.0

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
$25.12
Median
$25.12
Typical High
$25.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$25.12
Typical High
$33.11
BCBS
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$45.71
Typical High
$67.61
BCBS
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$39.81
Typical High
$39.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$147.91
Typical High
$407.38
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$50.12
Typical High
$57.54
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$162.18
Typical High
$323.59
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$51.29
Medica
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$39.81
Typical High
$186.21
Medica
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$16.60
Typical High
$46.77
United
Setting
Facility
Modifier
Global
Typical Low
$0.27
Median
$15.14
Typical High
$17.78
United
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$19.50
Typical High
$53.70