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

Utah 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 $3 · 10th–90th $3$70%50%90th$3Professionalmedian $9 · 10th–90th $3$510%10%10th90th$9$0.1$0.5$2.0$10.0$50.0

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
$3.24
Median
$3.24
Typical High
$3.24
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.24
Median
$7.76
Typical High
$51.29
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7.08
Median
$7.08
Typical High
$7.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$8.32
Molina
Setting
Professional
Modifier
Global
Typical Low
$7.08
Median
$8.71
Typical High
$11.75
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$8.51
Typical High
$13.49
Select Health
Setting
Facility
Modifier
Global
Typical Low
$12.02
Median
$12.02
Typical High
$12.02
Select Health
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$12.02
Typical High
$12.02
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$9.12
Median
$12.02
Typical High
$14.45
United
Setting
Facility
Modifier
Global
Typical Low
$3.98
Median
$4.68
Typical High
$5.01
United
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$5.01
Typical High
$9.12