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

Wisconsin 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 $10$220%20%40%10th90th$12Professionalmedian $11 · 10th–90th $6$210%20%10th90th$11$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
$6.92
Typical High
$6.92
Aetna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$10.23
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$12.02
Median
$12.02
Typical High
$19.95
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$11.22
Typical High
$13.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7.08
Median
$38.02
Typical High
$61.66
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$17.78
Typical High
$22.91
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$10.23
Typical High
$17.38
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$10.72
Median
$22.91
Typical High
$28.18
Medica
Setting
Facility
Modifier
Global
Typical Low
$6.76
Median
$12.02
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$5.89
Typical High
$13.18
Molina
Setting
Professional
Modifier
Global
Typical Low
$7.08
Median
$33.11
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$19.05
Median
$19.05
Typical High
$19.05
Network Health
Setting
Professional
Modifier
Global
Typical Low
$8.51
Median
$13.80
Typical High
$23.99
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$10.23
Typical High
$17.38
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$6.76
Typical High
$12.02
Quartz
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$18.20
Typical High
$30.20
Quartz
Setting
Facility
Modifier
Global
Typical Low
$7.08
Median
$24.55
Typical High
$79.43
Quartz
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$18.20
Typical High
$60.26
Security Health
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$12.02
Typical High
$12.02
Security Health
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$12.02
Typical High
$12.02
United
Setting
Facility
Modifier
Global
Typical Low
$3.89
Median
$5.37
Typical High
$12.02
United
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$5.89
Typical High
$10.23