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

Kansas 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 $12 · 10th–90th $4$150%20%10th90th$12Professionalmedian $13 · 10th–90th $7$130%50%10th$13$5.0$10.0$20.0$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
$14.13
Median
$14.13
Typical High
$14.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$7.94
Typical High
$14.79
BCBS
Setting
Facility
Modifier
Global
Typical Low
$11.22
Median
$11.75
Typical High
$12.59
BCBS
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$12.88
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
$15.49
Medica
Setting
Facility
Modifier
Global
Typical Low
$3.72
Median
$9.55
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$3.80
Median
$6.76
Typical High
$66.07
United
Setting
Facility
Modifier
Global
Typical Low
$4.79
Median
$13.80
Typical High
$13.80
United
Setting
Professional
Modifier
Global
Typical Low
$4.37
Median
$6.46
Typical High
$9.55