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

New Mexico 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 $3$130%10%10th90th$9Professionalmedian $8 · 10th–90th $4$130%10%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
$9.12
Median
$9.12
Typical High
$9.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.72
Median
$7.59
Typical High
$54.95
BCBS
Setting
Professional
Modifier
Global
Typical Low
$7.59
Median
$10.00
Typical High
$12.02
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7.59
Median
$7.59
Typical High
$7.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$6.46
Typical High
$18.62
Molina
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$12.59
Typical High
$21.88
Providence
Setting
Facility
Modifier
Global
Typical Low
$3.47
Median
$9.12
Typical High
$14.13
Providence
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$6.46
Typical High
$13.18
United
Setting
Facility
Modifier
Global
Typical Low
$4.90
Median
$5.37
Typical High
$12.88
United
Setting
Professional
Modifier
Global
Typical Low
$4.90
Median
$5.37
Typical High
$8.13