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

Nebraska 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 $14 · 10th–90th $6$790%10%20%10th90th$14Professionalmedian $9 · 10th–90th $4$110%20%40%10th90th$9$0.1$0.5$2.0$10.0$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
$11.22
Median
$11.22
Typical High
$11.22
Aetna
Setting
Professional
Modifier
Global
Typical Low
$4.07
Median
$8.71
Typical High
$11.22
BCBS
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$12.88
Typical High
$13.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.51
Typical High
$15.14
Cigna
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$15.49
Typical High
$28.18
Medica
Setting
Facility
Modifier
Global
Typical Low
$10.96
Median
$19.05
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$6.76
Typical High
$13.49
Midlands
Setting
Professional
Modifier
Global
Typical Low
$14.79
Median
$14.79
Typical High
$36.31
Midlands
Setting
Facility
Modifier
Global
Typical Low
$15.14
Median
$15.14
Typical High
$15.14
Midlands
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$33.88
Typical High
$36.31
United
Setting
Facility
Modifier
Global
Typical Low
$4.79
Median
$8.13
Typical High
$13.80
United
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$6.46
Typical High
$10.47