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

New Hampshire 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 $7 · 10th–90th $5$90%50%10th90th$7Professionalmedian $8 · 10th–90th $6$120%20%10th90th$8$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
$7.08
Median
$7.08
Typical High
$8.51
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$7.08
Typical High
$8.51
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$6.76
Typical High
$7.08
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$10.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$8.51
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$11.75
Typical High
$21.88
United
Setting
Facility
Modifier
Global
Typical Low
$3.55
Median
$5.13
Typical High
$5.62
United
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$7.76
Typical High
$11.75
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$17.38
Median
$17.38
Typical High
$17.78