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

Texas 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 $6$350%10%20%10th90th$11Professionalmedian $8 · 10th–90th $5$110%20%10th90th$8$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

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
$2.69
Median
$8.13
Typical High
$8.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$8.13
Typical High
$10.96
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$8.32
Median
$8.32
Typical High
$8.32
BCBS
Setting
Facility
Modifier
Global
Typical Low
$9.77
Median
$12.88
Typical High
$34.67
BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$6.76
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$7.76
Median
$10.23
Typical High
$15.49
Christus
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$79.43
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
$7.59
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$85.11
Typical High
$85.11
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$95.50
Typical High
$95.50
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$6.31
Median
$10.47
Typical High
$17.78
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$7.76
Median
$10.96
Typical High
$12.88
Molina
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$8.71
Typical High
$81.28
Providence
Setting
Facility
Modifier
Global
Typical Low
$6.31
Median
$10.23
Typical High
$17.78
Providence
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$6.46
Typical High
$8.13
United
Setting
Facility
Modifier
Global
Typical Low
$4.27
Median
$5.75
Typical High
$12.88
United
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$5.89
Typical High
$7.76
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$6.31
Median
$12.88
Typical High
$17.38