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

Arizona 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?

$8.13

Typical negotiated rate. In Arizona, October 2026.

Insurers have agreed to pay about $8.13 for this service. The price depends on where it is billed: about $8.13 from a physician practice, and about $14.13 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$8.13$5.75 to $12.02
FacilityA hospital or hospital-owned outpatient department$14.13$8.13 to $24.55

How much rates vary

Facilitymedian $14 · 10th to 90th $4 to $79Professionalmedian $8 · 10th to 90th $5 to $66
$5$10$20$50facility $14professional $8

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$8.13
Median
$8.13
Typical High
$8.13
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$1.20
Median
$1.20
Typical High
$1.20
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.81
Median
$0.81
Typical High
$0.81
Ambetter
Setting
Professional
Modifier
None
Typical Low
$10.96
Median
$10.96
Typical High
$10.96
BCBS Arizona
Setting
Facility
Modifier
None
Typical Low
$3.55
Median
$16.22
Typical High
$24.55
BCBS Arizona
Setting
Professional
Modifier
None
Typical Low
$10.47
Median
$12.02
Typical High
$21.88
Cigna
Setting
Facility
Modifier
None
Typical Low
$8.13
Median
$8.13
Typical High
$8.13
Cigna
Setting
Professional
Modifier
None
Typical Low
$6.92
Median
$6.92
Typical High
$8.13
Medica
Setting
Facility
Modifier
None
Typical Low
$8.13
Median
$13.49
Typical High
$79.43
Medica
Setting
Professional
Modifier
None
Typical Low
$5.25
Median
$7.59
Typical High
$66.07
United
Setting
Professional
Modifier
None
Typical Low
$5.13
Median
$5.75
Typical High
$8.51

Where Arizona 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.

Arizona· 34th of 51

$8.13

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.