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Ostomy Pouch, Urinary, for Use on Faceplate, Rubber

New Hampshire rates for HCPCS A4383

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

Rates data updated July 2026.

Facilitymedian $21 · 10th–90th $15$260%50%10th90th$21Professionalmedian $22 · 10th–90th $17$350%20%10th90th$22$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
$20.89
Median
$20.89
Typical High
$25.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$16.98
Median
$20.89
Typical High
$25.12
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$19.95
Cigna
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$26.30
Typical High
$30.90
Cigna
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$22.39
Typical High
$26.30
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$34.67
Typical High
$63.10
United
Setting
Facility
Modifier
Global
Typical Low
$10.23
Median
$15.14
Typical High
$16.22
United
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$22.39
Typical High
$34.67
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$52.48