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Ostomy Pouch, Drainable, One-Piece, Convex

Utah rates for HCPCS A4389

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

Rates data updated July 2026.

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

$6.17

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $6.17 for this service. The price depends on where it is billed: about $6.17 from a physician practice, and about $2.40 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$6.17$3.72 to $8.91
FacilityA hospital or hospital-owned outpatient department$2.40$2.40 to $2.95

How much rates vary

Facilitymedian $2 · 10th to 90th $2 to $5Professionalmedian $6 · 10th to 90th $2 to $38
$5$10$20facility $2professional $6

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
$2.40
Median
$2.40
Typical High
$2.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.40
Median
$5.62
Typical High
$38.02
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.25
Median
$5.25
Typical High
$5.25
Cigna
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$4.47
Typical High
$6.17
Molina
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$6.31
Typical High
$8.51
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$6.17
Typical High
$9.77
Select Health
Setting
Facility
Modifier
Global
Typical Low
$8.91
Median
$8.91
Typical High
$8.91
Select Health
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$8.91
Typical High
$8.91
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$8.91
Typical High
$10.72
United
Setting
Facility
Modifier
Global
Typical Low
$2.95
Median
$3.39
Typical High
$4.37
United
Setting
Professional
Modifier
Global
Typical Low
$2.88
Median
$3.72
Typical High
$5.50

Where Utah sits

The same service costs 2.2 times more in Hawaii 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· 22nd of 51

$6.17

HI $9.55CO $4.37

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.