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Assura Original 1-piece urostomy

Brand: Coloplast
Category: Pouches
System: 1-piece
Pouch type: Urostomy
Barrier type: Flat (from product name)
Opening: Not found in our sources
Filter: Not found in our sources
Box quantity: 10
Flange sizes: Not found in our sources
HCPCS code(s): A4391, A5071 (Coloplast product page (variant name))
Lowest cash price seen: From $75.53 / Box of 10 ($7.55 each)
Vitality Medical, Nov 4, 2026
Source: products.coloplast.us · checked Nov 4, 2026

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Sizes, codes and prices

Prices are cash prices one retailer listed on the date shown, per the retailer's unit. Retailer links are marked as sponsored for search engines and may become affiliate links later. We do not take referral fees from suppliers that bill Medicare. The retailer page says the manufacturer labels this item Rx only.

Code	Description / size	Box	HCPCS	Price seen
`5570`	Midi (7in / 265mL) - Stoma size: 10-55mm \| 3/8 - 2 1/4in, Opaque	10 per box	A5071	—
`5575`	Midi (7in / 265mL) - Stoma size: 10-55mm \| 3/8 - 2 1/4in, Transparent	10 per box	A5071	—
`5580`	Maxi (10 3/4in / 465mL) - Stoma size: 10-55mm \| 3/8 - 2 1/4in Opaque	10 per box	A5071	—
`5585`	Maxi (10 3/4in / 465mL) - Stoma size: 10-55mm \| 3/8 - 2 1/4in, Transparent	10 per box	A5071	—
`12471`	XPRO - Midi (9 1/2in / 265mL) - Stoma size: 10-55mm \| 3/8 - 2 1/4in, Opaque	10 per box	A4391	—
`12472`	XPRO - Midi (9 1/2in / 265mL) - Stoma size: 10-55mm \| 3/8 - 2 1/4in, Transparent	10 per box	A4391	—
`12474`	XPRO - Midi (9 1/2in / 375mL) - Stoma size: 10-55mm \| 3/8 - 2 1/4in, Transparent	10 per box	A4391	—
`14222`	Maxi (10 3/4in / 470mL) - Stoma size: 10-55mm \| 3/8 - 2 1/4in Transparent	10 per box	A5071	$75.53 / Box of 10 Vitality Medical · Nov 4, 2026

Medicare usual maximums for these codes

A4391: Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each. No usual maximum is listed for this code in the LCD table.
A5071: Ostomy pouch, urinary; with barrier attached (1 piece), each. Usual maximum in LCD L33828: 20 per month.

From our Medicare guide (LCD L33828). Informational only; coverage depends on your plan and documentation. Confirm with your supplier or plan.