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

Alaska rates for HCPCS A4392

Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (one piece), each

Rates data updated July 2026.

Facilitymedian $4 · 10th–90th $3$120%20%40%10th90th$4Professionalmedian $10 · 10th–90th $3$170%10%20%10th90th$10$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
Professional
Modifier
Global
Typical Low
$3.39
Median
$8.71
Typical High
$11.48
Cigna
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$6.92
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$12.59
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$3.16
Median
$8.13
Typical High
$11.75
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$11.75
Typical High
$37.15
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$10.00
Median
$11.22
Typical High
$11.22
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$9.12
Median
$11.22
Typical High
$11.75
Providence
Setting
Facility
Modifier
Global
Typical Low
$3.16
Median
$3.16
Typical High
$12.02
Providence
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$8.51
Typical High
$60.26
United
Setting
Facility
Modifier
Global
Typical Low
$3.80
Median
$4.37
Typical High
$4.47
United
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$5.75
Typical High
$23.44