go back

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

New Hampshire 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 $7 · 10th–90th $5$80%50%10th90th$7Professionalmedian $8 · 10th–90th $5$110%20%10th90th$8$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
$6.61
Median
$6.61
Typical High
$7.94
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$6.61
Typical High
$7.94
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.31
Median
$6.31
Typical High
$6.76
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7.59
Median
$7.59
Typical High
$10.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$6.46
Typical High
$7.94
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$10.96
Typical High
$20.42
United
Setting
Facility
Modifier
Global
Typical Low
$3.31
Median
$4.90
Typical High
$5.25
United
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$7.24
Typical High
$10.96
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$13.18
Median
$13.18
Typical High
$16.60