go back

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

Iowa 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 $11 · 10th–90th $6$340%10%10th90th$11Professionalmedian $11 · 10th–90th $7$170%10%20%10th90th$11$5.0$10.0$20.0$50.0$100.0

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
$7.94
Median
$9.77
Typical High
$11.22
Aetna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$10.72
Typical High
$11.75
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$15.14
Cigna
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$15.49
Typical High
$19.05
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$13.49
Typical High
$17.38
Medica
Setting
Facility
Modifier
Global
Typical Low
$9.12
Median
$15.14
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$8.13
Typical High
$22.39
Midlands
Setting
Professional
Modifier
Global
Typical Low
$14.79
Median
$15.49
Typical High
$17.38
Midlands
Setting
Facility
Modifier
Global
Typical Low
$15.14
Median
$15.14
Typical High
$15.14
Midlands
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$22.39
Typical High
$22.39
United
Setting
Facility
Modifier
Global
Typical Low
$4.37
Median
$6.17
Typical High
$13.80
United
Setting
Professional
Modifier
Global
Typical Low
$5.25
Median
$6.76
Typical High
$12.88
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$10.96
Typical High
$10.96