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

Hawaii 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 $4$90%20%10th90th$4Professionalmedian $12 · 10th–90th $6$120%50%10th90th$12$5.0$10.0$20.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.62
Median
$5.62
Typical High
$6.46
Cigna
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$7.59
Typical High
$9.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$10.72
Typical High
$14.45
HMSA
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$11.75
Typical High
$12.30
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$11.75
Typical High
$16.22
United
Setting
Facility
Modifier
Global
Typical Low
$3.72
Median
$3.80
Typical High
$4.47
United
Setting
Professional
Modifier
Global
Typical Low
$5.13
Median
$8.13
Typical High
$14.13