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Ostomy Pouch, Urinary, Extended Wear Barrier, Faucet Tap

California rates for HCPCS A4428

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

Rates data updated July 2026.

Facilitymedian $4 · 10th–90th $3$120%20%10th90th$4Professionalmedian $5 · 10th–90th $3$400%10%20%10th90th$5$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

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
$2.45
Median
$2.69
Typical High
$39.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.69
Median
$5.62
Typical High
$39.81
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3.39
Median
$4.37
Typical High
$10.96
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$4.57
Median
$4.79
Typical High
$10.23
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$9.55
Median
$12.59
Typical High
$19.05
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$16.60
Typical High
$33.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$6.46
Cigna
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$4.68
Typical High
$5.62
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$7.41
Median
$9.55
Typical High
$12.59
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$5.62
Median
$8.32
Typical High
$15.49
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$85.11
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$67.61
Typical High
$67.61
Molina
Setting
Professional
Modifier
Global
Typical Low
$9.12
Median
$9.12
Typical High
$9.12
Optum
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$2.69
Median
$8.71
Typical High
$12.30
Providence
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$4.68
Typical High
$8.91
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$17.38
Typical High
$17.38
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$7.41
Median
$10.96
Typical High
$18.20
United
Setting
Facility
Modifier
Global
Typical Low
$0.65
Median
$3.55
Typical High
$5.25
United
Setting
Professional
Modifier
Global
Typical Low
$3.47
Median
$4.07
Typical High
$9.77