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

Ohio 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 $8 · 10th–90th $5$120%20%10th90th$8Professionalmedian $7 · 10th–90th $5$120%20%10th90th$7$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
$7.24
Median
$9.55
Typical High
$12.02
Aetna
Setting
Professional
Modifier
Global
Typical Low
$6.17
Median
$7.24
Typical High
$9.77
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$6.92
Typical High
$15.14
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$11.75
Typical High
$11.75
CareSource
Setting
Facility
Modifier
Global
Typical Low
$5.75
Median
$9.77
Typical High
$13.80
CareSource
Setting
Professional
Modifier
Global
Typical Low
$7.41
Median
$10.23
Typical High
$15.49
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
$7.41
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$7.59
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$6.92
Molina
Setting
Professional
Modifier
Global
Typical Low
$5.25
Median
$7.24
Typical High
$10.47
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$13.18
Typical High
$23.99
United
Setting
Facility
Modifier
Global
Typical Low
$3.63
Median
$5.25
Typical High
$11.75
United
Setting
Professional
Modifier
Global
Typical Low
$3.72
Median
$5.50
Typical High
$8.13