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

Illinois rates for HCPCS A4392

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

Rates data updated October 2026.

How much does Ostomy Pouch, Urinary, One-Piece, Standard Wear, Convex cost?

$6.92

Typical negotiated rate. In Illinois, October 2026.

Insurers have agreed to pay about $6.92 for this service. The price depends on where it is billed: about $6.46 from a physician practice, and about $24.55 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$6.46$5.75 to $9.55
FacilityA hospital or hospital-owned outpatient department$24.55$11.75 to $56.23

How much rates vary

Facilitymedian $25 · 10th to 90th $7 to $95Professionalmedian $6 · 10th to 90th $5 to $15
$5$10$20$50$100facility $25professional $6

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$5.37
Median
$6.46
Typical High
$11.75
Aetna
Setting
Professional
Modifier
None
Typical Low
$5.37
Median
$6.46
Typical High
$9.77
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.79
Median
$0.95
Typical High
$1.48
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.52
Median
$0.65
Typical High
$0.98
BCBS Illinois
Setting
Facility
Modifier
None
Typical Low
$18.20
Median
$30.20
Typical High
$100.00
BCBS Illinois
Setting
Professional
Modifier
None
Typical Low
$5.50
Median
$8.71
Typical High
$8.71
Cigna
Setting
Facility
Modifier
None
Typical Low
$6.92
Median
$6.92
Typical High
$7.59
Cigna
Setting
Professional
Modifier
None
Typical Low
$5.89
Median
$5.89
Typical High
$8.13
Hally Health
Setting
Professional
Modifier
None
Typical Low
$9.77
Median
$14.13
Typical High
$20.42
Hally Health
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
None
Typical Low
$14.79
Median
$14.79
Typical High
$14.79
Molina
Setting
Professional
Modifier
None
Typical Low
$9.55
Median
$9.55
Typical High
$9.55
United
Setting
Professional
Modifier
None
Typical Low
$4.47
Median
$5.75
Typical High
$13.49

Where Illinois sits

The same service costs 2.1 times more in Idaho than in Colorado. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Illinois· 34th of 51

$6.92

ID $12.30CO $5.89

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.