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Ostomy Pouch, Urinary, Extended Wear Barrier, Faucet Tap

Hawaii 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$70%20%10th90th$4Professionalmedian $9 · 10th–90th $4$100%50%10th90th$9$5.0$10.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$4.47
Typical High
$5.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.75
Typical High
$7.24
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$8.51
Typical High
$11.48
HMSA
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$9.33
Typical High
$9.77
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$9.33
Typical High
$12.88
United
Setting
Facility
Modifier
Global
Typical Low
$2.95
Median
$3.09
Typical High
$3.55
United
Setting
Professional
Modifier
Global
Typical Low
$4.07
Median
$6.46
Typical High
$11.48