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

Illinois 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 $13 · 10th–90th $7$690%20%10th90th$13Professionalmedian $8 · 10th–90th $6$130%20%10th90th$8$0.1$0.5$2.0$10.0$50.0$200.0

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
$7.08
Median
$7.08
Typical High
$12.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$7.76
Typical High
$12.88
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$8.32
Median
$8.32
Typical High
$8.32
BCBS
Setting
Facility
Modifier
Global
Typical Low
$19.05
Median
$33.11
Typical High
$109.65
BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.17
Median
$9.55
Typical High
$9.55
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7.59
Median
$7.59
Typical High
$14.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$6.46
Typical High
$14.79
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$10.72
Median
$15.49
Typical High
$25.70
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$16.60
Median
$16.60
Typical High
$16.60
Molina
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$6.03
United
Setting
Facility
Modifier
Global
Typical Low
$4.07
Median
$12.88
Typical High
$12.88
United
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$6.31
Typical High
$10.96