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

Ohio 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 $9 · 10th–90th $5$140%20%10th90th$9Professionalmedian $9 · 10th–90th $6$140%10%20%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
$8.51
Median
$11.22
Typical High
$14.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$7.41
Median
$8.51
Typical High
$11.48
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$10.72
Median
$10.96
Typical High
$10.96
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$8.13
Typical High
$17.78
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$13.80
Typical High
$13.80
CareSource
Setting
Facility
Modifier
Global
Typical Low
$6.76
Median
$11.48
Typical High
$16.22
CareSource
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$12.02
Typical High
$18.20
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
$8.51
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$8.51
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$8.13
Molina
Setting
Professional
Modifier
Global
Typical Low
$7.41
Median
$10.23
Typical High
$14.45
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$15.49
Typical High
$28.18
United
Setting
Facility
Modifier
Global
Typical Low
$4.27
Median
$6.46
Typical High
$13.80
United
Setting
Professional
Modifier
Global
Typical Low
$4.37
Median
$6.46
Typical High
$9.33