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

North Dakota 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 $10 · 10th–90th $9$170%50%10th90th$10Professionalmedian $13 · 10th–90th $6$160%20%10th90th$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
$8.51
Median
$9.77
Typical High
$9.77
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$8.51
Typical High
$51.29
BCBS
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$14.79
Typical High
$15.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.51
Median
$8.51
Typical High
$8.51
Cigna
Setting
Professional
Modifier
Global
Typical Low
$8.51
Median
$15.49
Typical High
$19.05
Medica
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$11.48
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$5.25
Median
$6.31
Typical High
$13.49
United
Setting
Facility
Modifier
Global
Typical Low
$6.17
Median
$6.17
Typical High
$6.17
United
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$8.13
Typical High
$15.85