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

Pennsylvania 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 $9 · 10th–90th $6$600%20%10th90th$9Professionalmedian $7 · 10th–90th $5$110%20%40%10th90th$7$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$5.62
Median
$5.62
Typical High
$8.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$7.08
Typical High
$10.72
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$11.48
Typical High
$11.48
Cigna
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$15.85
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$7.08
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$7.41
Median
$12.88
Typical High
$22.39
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$11.75
Median
$11.75
Typical High
$11.75
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$8.13
Typical High
$11.75
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$5.62
Median
$5.62
Typical High
$8.91
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$5.62
Median
$7.08
Typical High
$9.55
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$6.03
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$10.47
Typical High
$10.47
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$20.42
Median
$42.66
Typical High
$66.07
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$10.96
Typical High
$10.96
United
Setting
Facility
Modifier
Global
Typical Low
$3.80
Median
$5.25
Typical High
$7.24
United
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$5.75
Typical High
$12.30