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Ostomy Pouch, Urinary, for Use on Faceplate, Rubber

New Mexico rates for HCPCS A4383

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

Rates data updated July 2026.

Facilitymedian $27 · 10th–90th $11$410%10%20%10th90th$27Professionalmedian $23 · 10th–90th $11$590%10%20%10th90th$23$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
$28.84
Median
$28.84
Typical High
$28.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$28.18
Typical High
$169.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$26.30
Typical High
$26.30
Cigna
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$22.39
Typical High
$48.98
Molina
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$39.81
Typical High
$60.26
Providence
Setting
Facility
Modifier
Global
Typical Low
$10.72
Median
$28.84
Typical High
$44.67
Providence
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$22.39
Typical High
$41.69
United
Setting
Facility
Modifier
Global
Typical Low
$15.14
Median
$16.60
Typical High
$39.81
United
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$16.60
Typical High
$25.12