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

Tennessee 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 $5$850%20%40%10th90th$12Professionalmedian $8 · 10th–90th $5$120%20%10th90th$8$5.0$10.0$20.0$50.0$100.0

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
$6.92
Median
$7.76
Typical High
$12.02
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$8.51
Typical High
$11.75
BCBS
Setting
Professional
Modifier
Global
Typical Low
$10.23
Median
$10.23
Typical High
$10.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$9.33
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$8.13
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$85.11
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$100.00
Typical High
$100.00
United
Setting
Facility
Modifier
Global
Typical Low
$5.13
Median
$6.17
Typical High
$13.80
United
Setting
Professional
Modifier
Global
Typical Low
$4.27
Median
$6.31
Typical High
$7.94