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

Massachusetts 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 $8 · 10th–90th $5$790%20%10th90th$8Professionalmedian $10 · 10th–90th $5$150%20%40%10th90th$10$5.0$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$5.01
Median
$5.01
Typical High
$5.01
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$6.03
Typical High
$15.85
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$10.96
Median
$11.22
Typical High
$79.43
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$9.33
Typical High
$13.80
BCBS
Setting
Facility
Modifier
Global
Typical Low
$6.31
Median
$6.31
Typical High
$19.05
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.13
Median
$6.92
Typical High
$7.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$8.13
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$3,630.78
Typical High
$9,772.37
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$10.00
Typical High
$15.14
Health New England
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$5.75
Typical High
$5.75
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$10.96
Median
$11.22
Typical High
$79.43
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$9.33
Typical High
$13.80
United
Setting
Facility
Modifier
Global
Typical Low
$3.72
Median
$4.79
Typical High
$11.75
United
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$9.33
Typical High
$10.23