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

North Carolina rates for HCPCS A4390

Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (one piece), each

Rates data updated October 2026.

How much does Ostomy Pouch, Drainable, One-Piece, Extended Wear, Convex cost?

$10.23

Typical negotiated rate. In North Carolina, October 2026.

Insurers have agreed to pay about $10.23 for this service. The price depends on where it is billed: about $10.23 from a physician practice, and about $8.13 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$10.23$8.51 to $10.96
FacilityA hospital or hospital-owned outpatient department$8.13$7.41 to $11.75

How much rates vary

Facilitymedian $8 · 10th to 90th $4 to $12Professionalmedian $10 · 10th to 90th $7 to $12
$5$10facility $8professional $10

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$11.75
Median
$11.75
Typical High
$11.75
Aetna
Setting
Professional
Modifier
None
Typical Low
$8.32
Median
$11.75
Typical High
$11.75
BCBS North Carolina
Setting
Facility
Modifier
None
Typical Low
$10.96
Median
$13.18
Typical High
$14.13
BCBS North Carolina
Setting
Professional
Modifier
None
Typical Low
$8.71
Median
$10.23
Typical High
$10.96
Cigna
Setting
Facility
Modifier
None
Typical Low
$8.13
Median
$8.13
Typical High
$8.51
Cigna
Setting
Professional
Modifier
None
Typical Low
$6.92
Median
$8.13
Typical High
$8.71
Medcost
Setting
Professional
Modifier
None
Typical Low
$6.31
Median
$6.76
Typical High
$9.55
Medcost
Setting
Facility
Modifier
None
Typical Low
$3.72
Median
$7.41
Typical High
$12.88
Medcost
Setting
Professional
Modifier
None
Typical Low
$8.91
Median
$10.00
Typical High
$12.88
United
Setting
Professional
Modifier
None
Typical Low
$4.47
Median
$6.31
Typical High
$8.51
5 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$1.29
Median
$1.78
Typical High
$1.78
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.85
Median
$1.17
Typical High
$1.17
Medcost
Setting
Professional
Modifier
51 · Multiple procedures
Typical Low
$4.47
Median
$5.01
Typical High
$15.14
Medcost
Setting
Professional
Modifier
SH · Second concurrent infusion
Typical Low
$4.47
Median
$4.47
Typical High
$4.47
Medcost
Setting
Professional
Modifier
SJ · Third+ concurrent infusion
Typical Low
$4.47
Median
$4.47
Typical High
$4.47

Where North Carolina sits

The same service costs 2.1 times more in Hawaii than in Colorado. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

North Carolina· 19th of 51

$10.23

HI $14.79CO $6.92

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.