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

Tennessee 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 $11 · 10th–90th $5$850%20%40%10th90th$11Professionalmedian $8 · 10th–90th $5$110%10%20%10th90th$8$5.0$10.0$20.0$50.0$100.0

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
$6.46
Median
$7.41
Typical High
$11.48
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.25
Median
$7.94
Typical High
$10.96
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$8.32
Median
$8.32
Typical High
$8.32
BCBS
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$9.55
Typical High
$10.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7.59
Median
$7.59
Typical High
$8.71
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$6.46
Typical High
$7.59
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$85.11
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$95.50
Typical High
$95.50
United
Setting
Facility
Modifier
Global
Typical Low
$4.79
Median
$5.75
Typical High
$12.88
United
Setting
Professional
Modifier
Global
Typical Low
$4.07
Median
$5.89
Typical High
$7.41