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

Nevada 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 $6$120%50%10th$12Professionalmedian $9 · 10th–90th $5$190%10%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
$11.75
Median
$11.75
Typical High
$11.75
Aetna
Setting
Professional
Modifier
Global
Typical Low
$7.59
Median
$10.23
Typical High
$58.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$7.08
Typical High
$8.91
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$11.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$6.92
Typical High
$9.55
Hometown Health
Setting
Professional
Modifier
Global
Typical Low
$7.76
Median
$11.75
Typical High
$23.44
Select Health
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$13.80
Typical High
$13.80
Select Health
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$12.30
Typical High
$13.80
United
Setting
Facility
Modifier
Global
Typical Low
$0.09
Median
$5.13
Typical High
$6.17
United
Setting
Professional
Modifier
Global
Typical Low
$5.25
Median
$7.24
Typical High
$14.45