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

Montana 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 $11 · 10th–90th $7$140%20%40%10th90th$11Professionalmedian $10 · 10th–90th $4$500%10%20%10th90th$10$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.16
Median
$9.12
Typical High
$50.12
BCBS
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$11.22
Typical High
$11.22
Cigna
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$12.02
Typical High
$12.02
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$12.02
Typical High
$12.02
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$8.71
Median
$11.22
Typical High
$21.88
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$11.22
Typical High
$21.88
Providence
Setting
Facility
Modifier
Global
Typical Low
$5.62
Median
$9.12
Typical High
$13.80
Providence
Setting
Professional
Modifier
Global
Typical Low
$8.51
Median
$12.02
Typical High
$79.43
United
Setting
Facility
Modifier
Global
Typical Low
$3.80
Median
$4.37
Typical High
$4.47
United
Setting
Professional
Modifier
Global
Typical Low
$4.37
Median
$4.79
Typical High
$6.61