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

Maine 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 $7 · 10th–90th $4$90%20%10th90th$7Professionalmedian $8 · 10th–90th $5$100%20%10th90th$8$5.0$10.0$20.0$50.0

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
$3.09
Median
$6.03
Typical High
$10.72
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$5.75
Typical High
$8.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$8.91
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$7.59
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$10.00
Typical High
$12.02
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$3.09
Median
$6.61
Typical High
$8.71
United
Setting
Facility
Modifier
Global
Typical Low
$3.09
Median
$4.37
Typical High
$6.17
United
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$9.77
Typical High
$10.00