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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 July 2026.

Facilitymedian $12 · 10th–90th $6$620%20%10th90th$12Professionalmedian $7 · 10th–90th $5$150%20%40%10th90th$7$0.1$0.5$2.0$10.0$50.0$200.0

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
$6.46
Median
$6.46
Typical High
$11.75
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.37
Median
$7.08
Typical High
$11.75
BCBS
Setting
Facility
Modifier
Global
Typical Low
$17.38
Median
$30.20
Typical High
$100.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$8.71
Typical High
$8.71
Cigna
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$12.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$12.59
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$9.77
Median
$16.60
Typical High
$21.38
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$14.79
Median
$14.79
Typical High
$14.79
Molina
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$5.50
United
Setting
Facility
Modifier
Global
Typical Low
$3.63
Median
$11.75
Typical High
$11.75
United
Setting
Professional
Modifier
Global
Typical Low
$4.07
Median
$5.75
Typical High
$10.00