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Ostomy Pouch, Urinary, Extended Wear, Convexity, Faucet Tap

Illinois rates for HCPCS A4430

Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (one piece), each

Rates data updated July 2026.

Facilitymedian $12 · 10th–90th $7$680%20%10th90th$12Professionalmedian $8 · 10th–90th $6$130%20%10th90th$8$0.1$0.5$2.0$10.0$50.0$200.0

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
$6.61
Median
$6.61
Typical High
$12.02
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$7.41
Typical High
$12.02
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$6.92
BCBS
Setting
Facility
Modifier
Global
Typical Low
$19.05
Median
$32.36
Typical High
$104.71
BCBS
Setting
Professional
Modifier
Global
Typical Low
$5.62
Median
$9.12
Typical High
$9.12
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7.08
Median
$7.08
Typical High
$13.49
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$13.18
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$10.72
Median
$14.45
Typical High
$25.12
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$15.49
Typical High
$15.49
Molina
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$5.75
Typical High
$10.00
United
Setting
Facility
Modifier
Global
Typical Low
$3.80
Median
$12.02
Typical High
$12.02
United
Setting
Professional
Modifier
Global
Typical Low
$4.17
Median
$5.89
Typical High
$10.47