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

Washington 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 $11 · 10th–90th $6$220%20%10th90th$11Professionalmedian $10 · 10th–90th $5$190%10%10th90th$10$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
$6.46
Median
$6.46
Typical High
$15.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.39
Median
$6.46
Typical High
$50.12
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$10.00
Median
$10.00
Typical High
$10.00
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$10.00
Typical High
$12.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$7.41
Typical High
$7.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$6.92
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$6.76
Median
$12.88
Typical High
$24.55
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$14.45
Typical High
$23.44
Molina
Setting
Professional
Modifier
Global
Typical Low
$7.94
Median
$8.71
Typical High
$64.57
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$10.23
Median
$11.22
Typical High
$11.48
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$11.48
Typical High
$13.80
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$9.55
Median
$10.00
Typical High
$18.62
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$9.55
Typical High
$11.22
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$10.00
Typical High
$12.88
United
Setting
Facility
Modifier
Global
Typical Low
$4.37
Median
$4.79
Typical High
$6.46
United
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$5.25
Typical High
$9.33
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$10.00
Typical High
$17.38