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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 July 2026.

Facilitymedian $12 · 10th–90th $5$240%10%20%10th90th$12Professionalmedian $11 · 10th–90th $7$120%50%10th90th$11$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

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
$11.75
Median
$11.75
Typical High
$11.75
Aetna
Setting
Professional
Modifier
Global
Typical Low
$7.59
Median
$11.75
Typical High
$11.75
BCBS
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$18.20
Typical High
$19.95
BCBS
Setting
Professional
Modifier
Global
Typical Low
$10.23
Median
$10.23
Typical High
$10.96
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
$8.71
Medcost
Setting
Professional
Modifier
Global
Typical Low
$6.31
Median
$6.76
Typical High
$9.55
Medcost
Setting
Facility
Modifier
Global
Typical Low
$5.89
Median
$11.75
Typical High
$19.50
United
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$8.71
Typical High
$13.80
United
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$6.46
Typical High
$9.33
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$85.11
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$100.00