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

Oregon 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 $12 · 10th–90th $10$130%50%10th90th$12Professionalmedian $10 · 10th–90th $4$140%10%10th90th$10$5.0$10.0$20.0$50.0$100.0$200.0$500.0

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
Professional
Modifier
Global
Typical Low
$3.72
Median
$6.46
Typical High
$10.23
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
$6.46
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$23.99
Typical High
$27.54
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$9.12
Median
$10.00
Typical High
$13.18
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$10.00
Typical High
$13.80
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$11.22
Median
$12.30
Typical High
$12.59
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$12.59
Typical High
$12.59
Providence
Setting
Facility
Modifier
Global
Typical Low
$7.24
Median
$11.48
Typical High
$15.14
Providence
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$12.02
Typical High
$79.43
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$14.13
Typical High
$14.13
United
Setting
Facility
Modifier
Global
Typical Low
$4.17
Median
$4.90
Typical High
$8.13
United
Setting
Professional
Modifier
Global
Typical Low
$4.17
Median
$5.37
Typical High
$10.23