go back

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

Washington 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 $7$240%20%10th90th$12Professionalmedian $10 · 10th–90th $5$210%10%20%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
$7.08
Median
$7.08
Typical High
$16.98
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.47
Median
$7.08
Typical High
$54.95
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$10.96
Median
$10.96
Typical High
$10.96
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$10.96
Typical High
$14.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7.59
Median
$7.94
Typical High
$8.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$6.46
Typical High
$7.59
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$7.41
Median
$13.80
Typical High
$26.92
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$7.41
Median
$15.85
Typical High
$25.70
Molina
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$9.77
Typical High
$64.57
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
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$10.47
Median
$10.96
Typical High
$20.42
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$10.47
Typical High
$12.30
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$10.96
Typical High
$14.13
United
Setting
Facility
Modifier
Global
Typical Low
$4.90
Median
$5.37
Typical High
$7.24
United
Setting
Professional
Modifier
Global
Typical Low
$4.90
Median
$5.75
Typical High
$10.23
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$6.31
Median
$10.96
Typical High
$19.50