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Ostomy Pouch, Urinary, for Use on Faceplate, Rubber

Montana rates for HCPCS A4383

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

Rates data updated July 2026.

Facilitymedian $39 · 10th–90th $26$480%20%10th90th$39Professionalmedian $33 · 10th–90th $11$850%10%20%10th90th$33$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
Professional
Modifier
Global
Typical Low
$10.72
Median
$31.62
Typical High
$169.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$41.69
Typical High
$41.69
Cigna
Setting
Professional
Modifier
Global
Typical Low
$22.39
Median
$33.88
Typical High
$41.69
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$38.90
Typical High
$75.86
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$38.90
Typical High
$75.86
Providence
Setting
Facility
Modifier
Global
Typical Low
$19.05
Median
$36.31
Typical High
$47.86
Providence
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$41.69
Typical High
$79.43
United
Setting
Facility
Modifier
Global
Typical Low
$13.18
Median
$15.14
Typical High
$15.14
United
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$16.60
Typical High
$22.39