go back

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

Illinois 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 $14 · 10th–90th $8$780%20%10th90th$14Professionalmedian $9 · 10th–90th $6$140%20%10th90th$9$0.1$0.5$2.0$10.0$50.0$200.0

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
$7.59
Median
$7.59
Typical High
$13.80
Aetna
Setting
Professional
Modifier
Global
Typical Low
$6.31
Median
$8.32
Typical High
$13.80
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$7.76
Median
$7.76
Typical High
$7.76
BCBS
Setting
Facility
Modifier
Global
Typical Low
$20.42
Median
$35.48
Typical High
$117.49
BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$10.23
Typical High
$10.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$15.14
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$14.79
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$16.22
Typical High
$32.36
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$17.38
Typical High
$17.38
Molina
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$6.03
United
Setting
Facility
Modifier
Global
Typical Low
$4.27
Median
$13.80
Typical High
$13.80
United
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$6.76
Typical High
$11.75