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

Utah 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 $3 · 10th–90th $3$70%50%90th$3Professionalmedian $8 · 10th–90th $3$500%10%10th90th$8$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
$3.16
Median
$3.16
Typical High
$3.16
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.16
Median
$7.41
Typical High
$50.12
Cigna
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$6.92
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$8.13
Molina
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$8.32
Typical High
$11.22
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$6.31
Median
$8.13
Typical High
$12.88
Select Health
Setting
Facility
Modifier
Global
Typical Low
$11.75
Median
$11.75
Typical High
$11.75
Select Health
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$11.75
Typical High
$11.75
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$11.75
Typical High
$14.13
United
Setting
Facility
Modifier
Global
Typical Low
$3.80
Median
$4.47
Typical High
$4.79
United
Setting
Professional
Modifier
Global
Typical Low
$3.80
Median
$4.79
Typical High
$7.24