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

Illinois rates for HCPCS A4390

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

Rates data updated July 2026.

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

$9.12

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $9.12 for this service. The price depends on where it is billed: about $8.91 from a physician practice, and about $13.80 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$8.91$7.59 to $11.22
FacilityA hospital or hospital-owned outpatient department$13.80$7.59 to $34.67

How much rates vary

Facilitymedian $14 · 10th to 90th $8 to $78Professionalmedian $9 · 10th to 90th $6 to $14
$5$10$20$50$100facility $14professional $9

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
$7.59
Median
$7.59
Typical High
$13.80
Aetna
Setting
Professional
Modifier
Global
Typical Low
$6.31
Median
$8.32
Typical High
$13.80
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$7.76
Median
$7.76
Typical High
$7.76
BCBS
Setting
Facility
Modifier
Global
Typical Low
$20.42
Median
$35.48
Typical High
$117.49
BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$10.23
Typical High
$10.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$15.14
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$14.79
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$16.22
Typical High
$32.36
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$17.38
Typical High
$17.38
Molina
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$6.03
United
Setting
Facility
Modifier
Global
Typical Low
$4.27
Median
$13.80
Typical High
$13.80
United
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$6.76
Typical High
$11.75

Where Illinois 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.

Illinois· 25th of 51

$9.12

HI $14.79CO $6.76

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.