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

Oklahoma 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 $10 · 10th–90th $7$100%50%10th$10Professionalmedian $7 · 10th–90th $3$100%20%10th90th$7$2.0$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
$6.76
Median
$6.76
Typical High
$6.76
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.39
Median
$6.76
Typical High
$6.76
BCBS
Setting
Facility
Modifier
Global
Typical Low
$10.00
Median
$10.00
Typical High
$10.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$10.00
Typical High
$10.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$4.90
Median
$6.92
Typical High
$7.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$8.13
Medica
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$7.94
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$3.24
Median
$5.50
Typical High
$13.80
United
Setting
Facility
Modifier
Global
Typical Low
$4.37
Median
$5.37
Typical High
$11.75
United
Setting
Professional
Modifier
Global
Typical Low
$3.24
Median
$4.79
Typical High
$6.92