go back

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

California 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 $6 · 10th–90th $5$180%20%10th90th$6Professionalmedian $8 · 10th–90th $4$590%10%10th90th$8$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

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
$3.63
Median
$3.98
Typical High
$58.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$8.32
Typical High
$58.88
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$5.01
Median
$6.46
Typical High
$15.85
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$7.08
Typical High
$15.14
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$18.62
Typical High
$28.18
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$23.99
Typical High
$50.12
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7.76
Median
$8.13
Typical High
$9.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$8.51
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$14.13
Typical High
$18.62
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$12.30
Typical High
$22.39
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$85.11
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$100.00
Typical High
$100.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$13.49
Median
$13.49
Typical High
$13.49
Optum
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$3.98
Median
$12.59
Typical High
$17.78
Providence
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$13.18
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$25.12
Typical High
$25.12
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$15.85
Typical High
$26.92
United
Setting
Facility
Modifier
Global
Typical Low
$0.93
Median
$5.13
Typical High
$7.76
United
Setting
Professional
Modifier
Global
Typical Low
$5.13
Median
$6.03
Typical High
$14.13