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

California 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 $5 · 10th–90th $4$150%20%10th90th$5Professionalmedian $7 · 10th–90th $3$500%10%20%10th90th$7$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
$3.09
Median
$3.39
Typical High
$50.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.39
Median
$7.08
Typical High
$50.12
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$11.75
Typical High
$11.75
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$4.27
Median
$5.50
Typical High
$13.49
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$6.03
Typical High
$12.88
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$12.02
Median
$15.85
Typical High
$23.99
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$20.42
Typical High
$42.66
Cigna
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$8.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$7.08
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$12.02
Typical High
$15.85
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$7.08
Median
$10.47
Typical High
$20.42
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
$57.54
Median
$85.11
Typical High
$85.11
Molina
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$11.48
Typical High
$11.48
Optum
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$3.39
Median
$10.72
Typical High
$15.14
Providence
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$11.22
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$21.38
Typical High
$21.38
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$13.49
Typical High
$22.91
United
Setting
Facility
Modifier
Global
Typical Low
$0.79
Median
$4.37
Typical High
$5.37
United
Setting
Professional
Modifier
Global
Typical Low
$4.37
Median
$5.13
Typical High
$12.02