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Ostomy Pouch, Closed, One-Piece, Convex

Utah rates for HCPCS A4387

Ostomy pouch, closed, with barrier attached, with built-in convexity (one piece), each

Rates data updated July 2026.

How much does Ostomy Pouch, Closed, One-Piece, Convex cost?

$2.51

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $2.51 for this service. The price depends on where it is billed: about $2.51 from a physician practice, and about $2.51 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$2.51$2.04 to $3.55
FacilityA hospital or hospital-owned outpatient department$2.51$2.51 to $2.51

How much rates vary

Facilitymedian $3 · 10th to 90th $1 to $3Professionalmedian $3 · 10th to 90th $2 to $14
$1$2$5$10facility $3professional $3

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$2.51
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.04
Median
$2.51
Typical High
$13.80
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.91
Median
$1.91
Typical High
$1.91
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.62
Median
$1.62
Typical High
$2.24
Molina
Setting
Professional
Modifier
Global
Typical Low
$1.86
Median
$2.29
Typical High
$3.09
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$1.74
Median
$2.24
Typical High
$3.55
Select Health
Setting
Facility
Modifier
Global
Typical Low
$3.24
Median
$3.24
Typical High
$3.24
Select Health
Setting
Professional
Modifier
Global
Typical Low
$1.58
Median
$3.24
Typical High
$3.24
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$2.40
Median
$3.24
Typical High
$3.80
United
Setting
Facility
Modifier
Global
Typical Low
$1.07
Median
$1.23
Typical High
$1.32
United
Setting
Professional
Modifier
Global
Typical Low
$1.05
Median
$1.32
Typical High
$2.88

Where Utah sits

The same service costs 2.1 times more in California than in Colorado. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Utah· 25th of 51

$2.51

CA $3.55CO $1.66

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.