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Ostomy Pouch, Urinary, One-Piece, Extended Wear, Convex

Iowa rates for HCPCS A4393

Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (one piece), each

Rates data updated July 2026.

Facilitymedian $10 · 10th–90th $5$320%10%10th90th$10Professionalmedian $10 · 10th–90th $6$170%20%10th90th$10$5.0$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
$7.59
Median
$9.12
Typical High
$10.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$10.00
Typical High
$10.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7.59
Median
$7.59
Typical High
$14.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$8.91
Median
$14.79
Typical High
$18.20
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$16.60
Typical High
$19.50
Medica
Setting
Facility
Modifier
Global
Typical Low
$8.71
Median
$13.80
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$5.37
Median
$7.76
Typical High
$21.38
Midlands
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$14.79
Typical High
$16.60
Midlands
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$14.13
Typical High
$14.13
Midlands
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$21.38
Typical High
$21.38
United
Setting
Facility
Modifier
Global
Typical Low
$4.17
Median
$5.75
Typical High
$12.88
United
Setting
Professional
Modifier
Global
Typical Low
$4.90
Median
$6.31
Typical High
$12.02
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$10.23
Typical High
$10.23