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

Louisiana 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%20%10th90th$11Professionalmedian $9 · 10th–90th $4$110%50%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
$7.76
Median
$9.55
Typical High
$9.55
Aetna
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$8.71
Typical High
$11.75
BCBS
Setting
Facility
Modifier
Global
Typical Low
$11.75
Median
$19.95
Typical High
$27.54
BCBS
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$9.55
Typical High
$9.55
Christus
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$218.78
Typical High
$218.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$8.91
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$13.18
United
Setting
Facility
Modifier
Global
Typical Low
$3.72
Median
$5.25
Typical High
$6.76
United
Setting
Professional
Modifier
Global
Typical Low
$3.80
Median
$6.31
Typical High
$8.13