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

Utah 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?

$9.55

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $9.55 for this service. The price depends on where it is billed: about $9.55 from a physician practice, and about $3.72 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$9.55$6.92 to $14.45
FacilityA hospital or hospital-owned outpatient department$3.72$3.72 to $4.47

How much rates vary

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

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
$3.72
Median
$3.72
Typical High
$3.72
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.72
Median
$8.71
Typical High
$58.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$8.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$9.55
Molina
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$9.77
Typical High
$13.18
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$7.41
Median
$9.55
Typical High
$15.14
Select Health
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$13.80
Typical High
$13.80
Select Health
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$13.80
Typical High
$13.80
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$10.23
Median
$13.80
Typical High
$16.60
United
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$5.25
Typical High
$5.25
United
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$5.75
Typical High
$9.33

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· 21st of 51

$9.55

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.