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

Idaho 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 $13 · 10th–90th $5$200%20%10th90th$13Professionalmedian $10 · 10th–90th $4$180%10%20%10th90th$10$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$9.12
Typical High
$18.20
BCBS
Setting
Facility
Modifier
Global
Typical Low
$9.77
Median
$12.88
Typical High
$21.88
BCBS
Setting
Professional
Modifier
Global
Typical Low
$14.45
Median
$15.14
Typical High
$15.14
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$8.71
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$9.55
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$3.72
Median
$12.59
Typical High
$18.20
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$12.88
Typical High
$13.80
Molina
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$14.45
Typical High
$30.20
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$9.55
Typical High
$15.14
Select Health
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$13.80
Typical High
$20.42
Select Health
Setting
Professional
Modifier
Global
Typical Low
$8.91
Median
$12.88
Typical High
$15.14
United
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$5.25
Typical High
$8.51
United
Setting
Professional
Modifier
Global
Typical Low
$5.25
Median
$5.75
Typical High
$7.76