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

Wisconsin 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 $12 · 10th–90th $9$210%20%40%10th90th$12Professionalmedian $11 · 10th–90th $6$190%10%20%10th90th$11$5.0$10.0$20.0$50.0$100.0

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
$6.61
Median
$6.61
Typical High
$6.61
Aetna
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$10.00
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$11.75
Median
$11.75
Typical High
$19.05
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$10.72
Typical High
$12.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$35.48
Typical High
$58.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$16.60
Typical High
$21.88
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$6.46
Median
$9.77
Typical High
$16.60
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$19.95
Typical High
$24.55
Medica
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$11.48
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$5.75
Typical High
$12.59
Molina
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$33.11
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$18.62
Median
$18.62
Typical High
$18.62
Network Health
Setting
Professional
Modifier
Global
Typical Low
$8.32
Median
$13.18
Typical High
$22.91
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$6.46
Median
$9.77
Typical High
$16.60
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$11.48
Quartz
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$17.38
Typical High
$28.84
Quartz
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$23.44
Typical High
$79.43
Quartz
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$17.38
Typical High
$57.54
Security Health
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$11.75
Typical High
$11.75
Security Health
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$11.75
Typical High
$11.75
United
Setting
Facility
Modifier
Global
Typical Low
$3.72
Median
$5.25
Typical High
$11.75
United
Setting
Professional
Modifier
Global
Typical Low
$3.80
Median
$5.75
Typical High
$9.77