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

Montana 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?

$11.48

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $11.48 for this service. The price depends on where it is billed: about $11.48 from a physician practice, and about $13.18 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 6 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$11.48$6.31 to $13.18
FacilityA hospital or hospital-owned outpatient department$13.18$10.23 to $14.13

How much rates vary

Facilitymedian $13 · 10th to 90th $8 to $16Professionalmedian $11 · 10th to 90th $4 to $59
$5$10$20$50facility $13professional $11

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
Professional
Modifier
Global
Typical Low
$3.72
Median
$10.72
Typical High
$58.88
BCBS
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$13.18
Typical High
$13.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$14.13
Typical High
$14.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$14.13
Typical High
$14.13
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$10.23
Median
$13.18
Typical High
$25.70
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$10.23
Median
$13.18
Typical High
$25.70
Providence
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$12.59
Typical High
$16.22
Providence
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$14.13
Typical High
$79.43
United
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$5.13
Typical High
$5.25
United
Setting
Professional
Modifier
Global
Typical Low
$5.13
Median
$5.75
Typical High
$7.76

Where Montana 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.

Montana· 12th of 51

$11.48

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.