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

South Carolina 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 $5$150%20%10th90th$9Professionalmedian $9 · 10th–90th $5$100%20%10th90th$9$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
$9.12
Median
$9.12
Typical High
$9.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.13
Median
$9.12
Typical High
$10.00
BCBS
Setting
Facility
Modifier
Global
Typical Low
$7.41
Median
$10.47
Typical High
$11.75
BCBS
Setting
Professional
Modifier
Global
Typical Low
$7.08
Median
$11.48
Typical High
$14.45
Cigna
Setting
Facility
Modifier
Global
Typical Low
$6.03
Median
$6.92
Typical High
$7.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$13.18
Medcost
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$5.75
Typical High
$7.41
Medcost
Setting
Facility
Modifier
Global
Typical Low
$7.08
Median
$10.47
Typical High
$18.62
Medcost
Setting
Professional
Modifier
Global
Typical Low
$3.16
Median
$3.16
Typical High
$3.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$7.76
Median
$7.76
Typical High
$7.76
United
Setting
Facility
Modifier
Global
Typical Low
$3.63
Median
$4.47
Typical High
$11.75
United
Setting
Professional
Modifier
Global
Typical Low
$3.80
Median
$5.50
Typical High
$7.41