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

Hawaii 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 $5 · 10th–90th $4$110%20%10th90th$5Professionalmedian $15 · 10th–90th $7$150%50%10th90th$15$5.0$10.0$20.0

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

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$7.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.51
Typical High
$11.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$13.49
Typical High
$18.20
HMSA
Setting
Professional
Modifier
Global
Typical Low
$14.79
Median
$14.79
Typical High
$15.49
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$14.79
Typical High
$20.89
United
Setting
Facility
Modifier
Global
Typical Low
$4.37
Median
$4.47
Typical High
$5.25
United
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$9.55
Typical High
$18.20