go back

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

New Jersey 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$140%50%10th90th$7Professionalmedian $8 · 10th–90th $4$120%10%10th90th$8$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
$6.61
Median
$6.61
Typical High
$6.61
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$6.61
Typical High
$11.75
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$8.91
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$8.13
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$7.94
Median
$12.30
Typical High
$17.78
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$8.91
Median
$8.91
Typical High
$8.91
United
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$6.31
Typical High
$13.80
United
Setting
Professional
Modifier
Global
Typical Low
$5.25
Median
$7.59
Typical High
$13.18