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

Montana 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 $12 · 10th–90th $8$150%20%10th90th$12Professionalmedian $11 · 10th–90th $5$550%10%20%10th90th$11$5.0$10.0$20.0$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
Professional
Modifier
Global
Typical Low
$3.47
Median
$10.00
Typical High
$54.95
BCBS
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$12.30
Typical High
$12.30
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7.59
Median
$13.18
Typical High
$13.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$13.18
Typical High
$13.18
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$9.77
Median
$12.30
Typical High
$23.99
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$9.77
Median
$12.30
Typical High
$23.99
Providence
Setting
Facility
Modifier
Global
Typical Low
$6.17
Median
$11.75
Typical High
$15.14
Providence
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$13.18
Typical High
$79.43
United
Setting
Facility
Modifier
Global
Typical Low
$4.27
Median
$4.90
Typical High
$4.90
United
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$5.37
Typical High
$7.24