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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 October 2026.

How much does Ostomy Pouch, Urinary, One-Piece, Standard Wear, Convex cost?

$12.02

Typical negotiated rate. In Montana, October 2026.

Insurers have agreed to pay about $12.02 for this service. The price depends on where it is billed: about $12.02 from a physician practice, and about $12.59 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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$12.02$8.91 to $12.02
FacilityA hospital or hospital-owned outpatient department$12.59$11.75 to $661

How much rates vary

Facilitymedian $13 · 10th to 90th $9 to $676Professionalmedian $12 · 10th to 90th $5 to $79
$5$10$20$50$100$200$500facility $13professional $12

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
Professional
Modifier
None
Typical Low
$3.16
Median
$9.77
Typical High
$15.49
BCBS Montana
Setting
Professional
Modifier
None
Typical Low
$11.22
Median
$11.22
Typical High
$11.22
Cigna
Setting
Facility
Modifier
None
Typical Low
$10.72
Median
$12.02
Typical High
$12.02
Cigna
Setting
Professional
Modifier
None
Typical Low
$9.77
Median
$12.02
Typical High
$12.02
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$8.71
Median
$14.45
Typical High
$676.08
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$11.75
Median
$12.88
Typical High
$707.95
Providence
Setting
Facility
Modifier
None
Typical Low
$6.92
Median
$12.02
Typical High
$12.02
Providence
Setting
Professional
Modifier
None
Typical Low
$8.91
Median
$12.02
Typical High
$79.43
United
Setting
Professional
Modifier
None
Typical Low
$4.57
Median
$4.79
Typical High
$8.13

Where Montana 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.

Montana· 2nd of 51

$12.02

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.