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

South 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 $10 · 10th–90th $5$170%20%10th90th$10Professionalmedian $10 · 10th–90th $5$110%20%40%10th90th$10$0.1$0.5$2.0$10.0$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
$10.00
Median
$10.00
Typical High
$10.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$10.00
Typical High
$10.96
BCBS
Setting
Facility
Modifier
Global
Typical Low
$8.32
Median
$11.48
Typical High
$12.88
BCBS
Setting
Professional
Modifier
Global
Typical Low
$8.91
Median
$12.88
Typical High
$16.22
Cigna
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$7.59
Typical High
$7.94
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$6.46
Typical High
$14.79
Medcost
Setting
Professional
Modifier
Global
Typical Low
$6.31
Median
$6.31
Typical High
$8.13
Medcost
Setting
Facility
Modifier
Global
Typical Low
$7.08
Median
$11.75
Typical High
$20.42
Medcost
Setting
Professional
Modifier
Global
Typical Low
$3.47
Median
$3.47
Typical High
$4.27
Molina
Setting
Professional
Modifier
Global
Typical Low
$8.51
Median
$8.51
Typical High
$8.51
United
Setting
Facility
Modifier
Global
Typical Low
$4.07
Median
$4.90
Typical High
$12.88
United
Setting
Professional
Modifier
Global
Typical Low
$4.17
Median
$6.03
Typical High
$8.13