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

North Dakota 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 $9 · 10th–90th $8$150%50%10th90th$9Professionalmedian $12 · 10th–90th $5$150%10%20%10th90th$12$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
Facility
Modifier
Global
Typical Low
$8.13
Median
$9.12
Typical High
$9.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.72
Median
$8.13
Typical High
$47.86
BCBS
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$13.80
Typical High
$15.14
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7.94
Median
$7.94
Typical High
$7.94
Cigna
Setting
Professional
Modifier
Global
Typical Low
$7.94
Median
$14.79
Typical High
$18.20
Medica
Setting
Facility
Modifier
Global
Typical Low
$6.17
Median
$10.96
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$4.90
Median
$5.89
Typical High
$12.59
United
Setting
Facility
Modifier
Global
Typical Low
$5.75
Median
$5.75
Typical High
$5.75
United
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$7.76
Typical High
$14.79