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

Wyoming 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 $6 · 10th–90th $5$130%20%10th90th$6Professionalmedian $11 · 10th–90th $6$130%20%10th90th$11$10.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$5.75
Typical High
$11.75
BCBS
Setting
Facility
Modifier
Global
Typical Low
$13.18
Median
$13.18
Typical High
$13.18
BCBS
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$13.18
Typical High
$13.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$8.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$8.13
United
Setting
Facility
Modifier
Global
Typical Low
$5.13
Median
$5.75
Typical High
$6.31
United
Setting
Professional
Modifier
Global
Typical Low
$5.13
Median
$5.75
Typical High
$7.76