go back

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

Pennsylvania 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 $13 · 10th–90th $7$720%20%10th90th$13Professionalmedian $8 · 10th–90th $6$130%20%10th90th$8$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
$6.61
Median
$6.61
Typical High
$10.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$8.32
Typical High
$12.59
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$13.80
Typical High
$13.80
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$8.71
Typical High
$8.71
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$13.49
Median
$13.49
Typical High
$13.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$18.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$8.32
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$7.59
Median
$15.14
Typical High
$25.70
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$13.80
Typical High
$13.80
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$9.55
Typical High
$13.80
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$9.33
Typical High
$10.00
Independence Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$8.71
Typical High
$8.71
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$10.47
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$8.32
Typical High
$11.22
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$23.99
Median
$50.12
Typical High
$77.62
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$12.88
Typical High
$12.88
United
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$6.17
Typical High
$8.51
United
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$6.76
Typical High
$15.14