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Ostomy Pouch, Urinary, for Use on Faceplate, Rubber

New York rates for HCPCS A4383

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

Rates data updated July 2026.

Facilitymedian $30 · 10th–90th $17$550%20%10th90th$30Professionalmedian $24 · 10th–90th $17$560%20%10th90th$24$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$16.98
Median
$23.99
Typical High
$44.67
Aetna
Setting
Professional
Modifier
Global
Typical Low
$16.60
Median
$23.99
Typical High
$37.15
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$63.10
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$33.11
Typical High
$33.11
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$33.11
Typical High
$33.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$26.30
Typical High
$54.95
Cigna
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$22.39
Typical High
$22.39
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$66.07
Typical High
$154.88
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$42.66
Typical High
$75.86
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$31.62
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$28.18
Typical High
$30.20
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$38.90
Typical High
$45.71
United
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$16.60
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$26.30
Typical High
$66.07
Univera
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$28.18
Typical High
$31.62
Univera
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$28.18
Typical High
$30.20