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

New Hampshire 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 $6 · 10th–90th $4$70%50%10th90th$6Professionalmedian $7 · 10th–90th $5$100%20%10th90th$7$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
Facility
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$7.24
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$6.03
Typical High
$7.24
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$5.75
Typical High
$6.03
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
$18.62
United
Setting
Facility
Modifier
Global
Typical Low
$3.02
Median
$4.37
Typical High
$4.79
United
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$6.61
Typical High
$10.00
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$15.14