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

Michigan 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?

$10.23

Typical negotiated rate. In Michigan, October 2026.

Insurers have agreed to pay about $10.23 for this service. The price depends on where it is billed: about $9.77 from a physician practice, and about $18.20 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 8 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$9.77$8.32 to $11.48
FacilityA hospital or hospital-owned outpatient department$18.20$7.41 to $33.88

How much rates vary

Facilitymedian $18 · 10th to 90th $7 to $50Professionalmedian $10 · 10th to 90th $5 to $12
$5$10$20$50$100facility $18professional $10

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
$10.23
Median
$10.23
Typical High
$10.72
Aetna
Setting
Professional
Modifier
None
Typical Low
$10.23
Median
$10.72
Typical High
$10.72
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$1.55
Median
$1.62
Typical High
$1.62
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$1.02
Median
$1.07
Typical High
$1.07
Ambetter
Setting
Professional
Modifier
None
Typical Low
$11.75
Median
$11.75
Typical High
$11.75
BCBS Michigan
Setting
Facility
Modifier
None
Typical Low
$13.80
Median
$33.88
Typical High
$64.57
BCBS Michigan
Setting
Professional
Modifier
None
Typical Low
$10.96
Median
$11.48
Typical High
$11.48
CareSource
Setting
Facility
Modifier
None
Typical Low
$7.41
Median
$7.41
Typical High
$7.41
Cigna
Setting
Facility
Modifier
None
Typical Low
$6.92
Median
$6.92
Typical High
$7.41
Cigna
Setting
Professional
Modifier
None
Typical Low
$5.89
Median
$5.89
Typical High
$7.59
Health Alliance Plan
Setting
Facility
Modifier
None
Typical Low
$8.32
Median
$9.33
Typical High
$24.55
Health Alliance Plan
Setting
Professional
Modifier
None
Typical Low
$7.41
Median
$9.12
Typical High
$11.75
Health Alliance Plan
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$1.32
Median
$1.32
Typical High
$1.32
Health Alliance Plan
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
Priority Health
Setting
Facility
Modifier
None
Typical Low
$6.92
Median
$6.92
Typical High
$7.41
Priority Health
Setting
Professional
Modifier
None
Typical Low
$5.89
Median
$5.89
Typical High
$8.13
United
Setting
Professional
Modifier
None
Typical Low
$4.07
Median
$5.37
Typical High
$7.59
1 more rate with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
BCBS Michigan
Setting
Professional
Modifier
RR · Rental
Typical Low
$11.48
Median
$11.48
Typical High
$11.48

Where Michigan 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.

Michigan· 10th of 51

$10.23

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.