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

North Carolina 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 $11 · 10th–90th $5$220%20%10th90th$11Professionalmedian $10 · 10th–90th $6$110%20%40%10th90th$10$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

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
$10.96
Median
$10.96
Typical High
$10.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$7.08
Median
$10.96
Typical High
$10.96
BCBS
Setting
Facility
Modifier
Global
Typical Low
$13.18
Median
$16.98
Typical High
$18.62
BCBS
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$9.55
Typical High
$10.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7.59
Median
$7.59
Typical High
$8.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$6.46
Typical High
$8.13
Medcost
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$6.31
Typical High
$9.12
Medcost
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$11.22
Typical High
$18.62
United
Setting
Facility
Modifier
Global
Typical Low
$4.27
Median
$8.13
Typical High
$12.88
United
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$6.03
Typical High
$8.91
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$85.11
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$95.50