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Ostomy Pouch, Drainable, One-Piece, Extended Wear, Convex

Alaska rates for HCPCS A4390

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

Rates data updated October 2026.

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

$13.18

Typical negotiated rate. In Alaska, October 2026.

Insurers have agreed to pay about $13.18 for this service. The price depends on where it is billed: about $13.18 from a physician practice, and about $12.88 from a hospital or other facility.

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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$13.18$11.48 to $13.18
FacilityA hospital or hospital-owned outpatient department$12.88$8.71 to $13.18

How much rates vary

Facilitymedian $13 · 10th to 90th $8 to $13Professionalmedian $13 · 10th to 90th $7 to $14
$5$10$20$50facility $13professional $13

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$12.88
Median
$12.88
Typical High
$12.88
Aetna
Setting
Professional
Modifier
None
Typical Low
$5.89
Median
$12.88
Typical High
$12.88
Cigna
Setting
Facility
Modifier
None
Typical Low
$8.13
Median
$8.13
Typical High
$8.71
Cigna
Setting
Professional
Modifier
None
Typical Low
$6.92
Median
$6.92
Typical High
$15.85
Moda Health
Setting
Facility
Modifier
None
Typical Low
$12.88
Median
$13.18
Typical High
$13.18
Moda Health
Setting
Professional
Modifier
None
Typical Low
$11.48
Median
$13.18
Typical High
$18.62
Premera BCBS
Setting
Facility
Modifier
None
Typical Low
$11.75
Median
$11.75
Typical High
$13.18
Premera BCBS
Setting
Professional
Modifier
None
Typical Low
$11.75
Median
$13.18
Typical High
$13.49
Providence
Setting
Facility
Modifier
None
Typical Low
$3.72
Median
$8.71
Typical High
$18.62
Providence
Setting
Professional
Modifier
None
Typical Low
$6.92
Median
$8.71
Typical High
$60.26
United
Setting
Professional
Modifier
None
Typical Low
$6.61
Median
$6.76
Typical High
$30.90

Where Alaska sits

The same service costs 2.1 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.

Alaska· 6th of 51

$13.18

HI $14.79CO $6.92

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.