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

Minnesota 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 $38 · 10th–90th $8$1020%10%10th90th$38Professionalmedian $13 · 10th–90th $8$150%20%40%10th90th$13$0.1$0.5$2.0$10.0$50.0

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
$8.13
Median
$8.13
Typical High
$8.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$4.37
Median
$8.13
Typical High
$10.47
BCBS
Setting
Facility
Modifier
Global
Typical Low
$11.75
Median
$14.79
Typical High
$21.88
BCBS
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$12.59
Typical High
$12.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$47.86
Typical High
$131.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$14.79
Median
$16.60
Typical High
$18.62
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$52.48
Typical High
$102.33
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$14.79
Median
$14.79
Typical High
$16.22
Medica
Setting
Facility
Modifier
Global
Typical Low
$5.37
Median
$12.59
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$3.55
Median
$5.37
Typical High
$13.80
United
Setting
Facility
Modifier
Global
Typical Low
$4.17
Median
$4.90
Typical High
$5.75
United
Setting
Professional
Modifier
Global
Typical Low
$4.17
Median
$6.31
Typical High
$17.38