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

Arkansas 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 $398,107 · 10th–90th $11$933,2540%10%20%10th90th$398,107Professionalmedian $8 · 10th–90th $4$120%20%40%10th90th$8$5.0$50.0$500.0$5.0K$50.0K$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
$10.72
Median
$10.72
Typical High
$10.72
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.72
Median
$10.23
Typical High
$11.75
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$7.59
Median
$7.59
Typical High
$7.59
BCBS
Setting
Facility
Modifier
Global
Typical Low
$218,776.16
Median
$524,807.46
Typical High
$954,992.59
BCBS
Setting
Professional
Modifier
Global
Typical Low
$16.98
Median
$16.98
Typical High
$16.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7.76
Median
$8.13
Typical High
$15.14
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.37
Median
$6.92
Typical High
$9.55
Qualchoice
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$8.71
Typical High
$8.71
United
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$5.75
Typical High
$8.51
United
Setting
Professional
Modifier
Global
Typical Low
$3.80
Median
$6.03
Typical High
$8.71