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

Alaska 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 $8 · 10th–90th $4$140%20%40%10th90th$8Professionalmedian $13 · 10th–90th $4$210%20%10th90th$13$5.0$10.0$20.0$50.0

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
Professional
Modifier
Global
Typical Low
$3.98
Median
$10.23
Typical High
$13.49
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
$15.85
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$3.72
Median
$12.88
Typical High
$13.80
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$13.80
Typical High
$44.67
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$11.75
Median
$13.18
Typical High
$13.18
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$13.18
Typical High
$13.80
Providence
Setting
Facility
Modifier
Global
Typical Low
$3.72
Median
$3.72
Typical High
$14.13
Providence
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$10.00
Typical High
$60.26
United
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$5.13
Typical High
$5.25
United
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$6.76
Typical High
$27.54