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

Missouri 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$270%20%10th90th$11Professionalmedian $8 · 10th–90th $6$160%20%10th90th$8$1.0$2.0$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
$5.75
Median
$13.49
Typical High
$13.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$8.71
Typical High
$58.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$7.08
Typical High
$12.59
BCBS
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$13.80
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$12.02
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$8.13
Medica
Setting
Facility
Modifier
Global
Typical Low
$6.76
Median
$11.48
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$6.76
Typical High
$66.07
United
Setting
Facility
Modifier
Global
Typical Low
$5.13
Median
$8.51
Typical High
$13.80
United
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$6.76
Typical High
$10.23