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Ostomy Pouch, Drainable, with Barrier, with Filter

Wisconsin rates for HCPCS A4424

Ostomy pouch, drainable, with barrier attached, with filter (one piece), each

Rates data updated July 2026.

Facilitymedian $7 · 10th–90th $5$120%20%40%10th90th$7Professionalmedian $6 · 10th–90th $3$110%20%10th90th$6$2.0$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
$3.89
Median
$3.89
Typical High
$3.89
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.89
Median
$3.89
Typical High
$5.75
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$6.76
Median
$6.76
Typical High
$11.22
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.31
Median
$6.31
Typical High
$7.41
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.98
Median
$21.38
Typical High
$35.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$3.39
Median
$10.00
Typical High
$12.88
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$3.72
Median
$5.75
Typical High
$9.55
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$10.47
Typical High
$12.88
Medica
Setting
Facility
Modifier
Global
Typical Low
$3.80
Median
$6.61
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$2.82
Median
$3.31
Typical High
$7.24
Molina
Setting
Professional
Modifier
Global
Typical Low
$2.95
Median
$33.11
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$10.72
Median
$10.72
Typical High
$10.72
Network Health
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$7.59
Typical High
$13.18
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$3.72
Median
$5.75
Typical High
$9.55
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$3.80
Median
$3.80
Typical High
$6.61
Quartz
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$10.23
Typical High
$16.98
Quartz
Setting
Facility
Modifier
Global
Typical Low
$3.98
Median
$13.80
Typical High
$79.43
Quartz
Setting
Professional
Modifier
Global
Typical Low
$3.39
Median
$10.00
Typical High
$33.88
Security Health
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$6.76
Typical High
$6.76
Security Health
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$6.76
Typical High
$6.76
United
Setting
Facility
Modifier
Global
Typical Low
$2.19
Median
$3.02
Typical High
$6.76
United
Setting
Professional
Modifier
Global
Typical Low
$2.19
Median
$3.31
Typical High
$5.75