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

Colorado 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 $10 · 10th–90th $4$170%10%10th90th$10Professionalmedian $6 · 10th–90th $6$100%20%40%10th90th$6$0.1$0.5$2.0$10.0$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
Facility
Modifier
Global
Typical Low
$5.75
Median
$5.75
Typical High
$10.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$5.89
Typical High
$8.71
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$6.92
Typical High
$12.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$8.51
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$12.02
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$3.72
Median
$10.00
Typical High
$18.62
Denver HMP
Setting
Professional
Modifier
Global
Typical Low
$3.72
Median
$3.72
Typical High
$3.72
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$13.80
Typical High
$21.88
Select Health
Setting
Facility
Modifier
Global
Typical Low
$14.45
Median
$25.12
Typical High
$28.84
Select Health
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$13.80
Typical High
$16.98
United
Setting
Facility
Modifier
Global
Typical Low
$5.13
Median
$6.17
Typical High
$13.80
United
Setting
Professional
Modifier
Global
Typical Low
$5.13
Median
$5.75
Typical High
$8.51