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

Nationwide rates for HCPCS A4390

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

Rates data updated July 2026.

Facilitymedian $9 · 10th–90th $5$300%20%10th90th$9Professionalmedian $9 · 10th–90th $6$140%20%40%10th90th$9$0.1$2.0$50.0$1.0K$20.0K$500.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$5.89
Median
$8.71
Typical High
$13.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.62
Median
$8.51
Typical High
$12.02
BCBS
Setting
Facility
Modifier
Global
Typical Low
$5.01
Median
$6.46
Typical High
$15.85
BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$7.41
Typical High
$15.14
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.51
Typical High
$50.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$19.05
United
Setting
Facility
Modifier
Global
Typical Low
$4.37
Median
$6.03
Typical High
$13.80
United
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$6.76
Typical High
$12.02