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Ostomy Pouch, Urinary, Extended Wear Barrier, Faucet Tap

Massachusetts 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 $8 · 10th–90th $4$790%20%10th90th$8Professionalmedian $8 · 10th–90th $4$120%20%40%10th90th$8$5.0$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$3.98
Median
$3.98
Typical High
$3.98
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$4.79
Typical High
$12.59
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$8.71
Median
$8.91
Typical High
$79.43
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$3.55
Median
$7.59
Typical High
$10.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$7.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$4.68
Typical High
$6.46
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$3,630.78
Typical High
$9,772.37
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$7.94
Median
$7.94
Typical High
$12.02
Health New England
Setting
Professional
Modifier
Global
Typical Low
$4.37
Median
$4.37
Typical High
$4.37
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$8.71
Median
$8.91
Typical High
$79.43
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$3.55
Median
$7.59
Typical High
$10.96
United
Setting
Facility
Modifier
Global
Typical Low
$2.95
Median
$3.89
Typical High
$9.33
United
Setting
Professional
Modifier
Global
Typical Low
$3.55
Median
$7.41
Typical High
$8.13