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

Pennsylvania 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 $6$680%20%10th90th$10Professionalmedian $8 · 10th–90th $5$130%20%40%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
$6.17
Median
$6.17
Typical High
$9.77
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$7.76
Typical High
$12.02
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$12.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7.59
Median
$7.59
Typical High
$17.38
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$6.46
Typical High
$7.76
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$14.13
Typical High
$24.55
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$12.88
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$7.76
Median
$9.12
Typical High
$12.88
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$8.91
Median
$9.55
Typical High
$9.55
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$6.17
Median
$6.17
Typical High
$9.77
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$5.37
Median
$7.76
Typical High
$10.47
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$6.61
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$11.48
Typical High
$11.48
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$25.12
Median
$45.71
Typical High
$74.13
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$9.12
Median
$12.02
Typical High
$12.02
United
Setting
Facility
Modifier
Global
Typical Low
$4.27
Median
$5.75
Typical High
$8.13
United
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$6.31
Typical High
$14.13