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

New York 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 $6$190%20%10th90th$10Professionalmedian $9 · 10th–90th $6$190%20%10th90th$9$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$5.89
Median
$8.32
Typical High
$15.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.62
Median
$8.32
Typical High
$12.59
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$7.08
Median
$8.91
Typical High
$19.05
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$10.47
Median
$11.22
Typical High
$11.22
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$11.22
Typical High
$11.22
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.51
Typical High
$18.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$9.55
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$22.39
Typical High
$52.48
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$7.59
Median
$13.80
Typical High
$25.70
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$8.51
Median
$8.51
Typical High
$8.91
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$8.51
Median
$9.77
Typical High
$9.77
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$9.12
Median
$9.12
Typical High
$9.12
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$18.20
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$8.32
Median
$13.18
Typical High
$15.49
United
Setting
Facility
Modifier
Global
Typical Low
$4.68
Median
$5.75
Typical High
$38.02
United
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$8.51
Typical High
$23.44
Univera
Setting
Facility
Modifier
Global
Typical Low
$8.51
Median
$9.55
Typical High
$9.77
Univera
Setting
Professional
Modifier
Global
Typical Low
$8.51
Median
$9.77
Typical High
$9.77