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

New York 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 $10 · 10th–90th $5$170%20%10th90th$10Professionalmedian $8 · 10th–90th $5$170%20%10th90th$8$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$5.50
Median
$7.76
Typical High
$14.45
Aetna
Setting
Professional
Modifier
Global
Typical Low
$4.37
Median
$7.76
Typical High
$12.02
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$8.51
Typical High
$17.78
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$9.77
Median
$10.47
Typical High
$10.47
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$10.47
Typical High
$10.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7.59
Median
$7.94
Typical High
$17.38
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$6.46
Typical High
$8.91
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$21.38
Typical High
$48.98
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$7.24
Median
$12.88
Typical High
$24.55
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$9.55
Median
$9.55
Typical High
$10.00
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$9.12
Median
$9.12
Typical High
$9.55
Fidelis
Setting
Professional
Modifier
Global
Typical Low
$7.08
Median
$7.08
Typical High
$7.08
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$8.13
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$20.42
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$7.76
Median
$12.30
Typical High
$14.45
United
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$5.75
Typical High
$36.31
United
Setting
Professional
Modifier
Global
Typical Low
$4.57
Median
$8.32
Typical High
$21.88
Univera
Setting
Facility
Modifier
Global
Typical Low
$9.12
Median
$9.12
Typical High
$10.00
Univera
Setting
Professional
Modifier
Global
Typical Low
$9.12
Median
$9.12
Typical High
$9.55