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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 July 2026.

Facilitymedian $12 · 10th–90th $5$520%20%10th90th$12Professionalmedian $9 · 10th–90th $5$110%20%10th90th$9$0.1$0.5$2.0$10.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$8.71
Median
$8.71
Typical High
$8.71
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.47
Median
$7.24
Typical High
$9.77
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$11.75
Typical High
$11.75
BCBS
Setting
Facility
Modifier
Global
Typical Low
$15.14
Median
$34.67
Typical High
$66.07
BCBS
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$11.48
Typical High
$11.75
CareSource
Setting
Facility
Modifier
Global
Typical Low
$7.41
Median
$7.41
Typical High
$7.41
Cigna
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$7.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$7.59
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$8.32
Median
$9.33
Typical High
$23.99
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$9.12
Typical High
$14.13
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$9.33
United
Setting
Facility
Modifier
Global
Typical Low
$3.16
Median
$4.47
Typical High
$7.24
United
Setting
Professional
Modifier
Global
Typical Low
$3.80
Median
$5.37
Typical High
$8.13