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Ostomy Pouch, Urinary, Extended Wear Barrier, Faucet Tap

Michigan 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 $10 · 10th–90th $4$420%10%20%10th90th$10Professionalmedian $7 · 10th–90th $4$90%10%20%10th90th$7$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
$6.92
Median
$6.92
Typical High
$6.92
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.82
Median
$5.75
Typical High
$7.76
BCBS
Setting
Facility
Modifier
Global
Typical Low
$12.02
Median
$27.54
Typical High
$52.48
BCBS
Setting
Professional
Modifier
Global
Typical Low
$9.12
Median
$9.12
Typical High
$9.55
CareSource
Setting
Facility
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$5.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$5.75
Cigna
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$4.47
Typical High
$6.46
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$6.46
Median
$7.24
Typical High
$19.05
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$7.24
Typical High
$11.22
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$4.47
Typical High
$7.59
United
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$3.55
Typical High
$5.75
United
Setting
Professional
Modifier
Global
Typical Low
$3.02
Median
$4.27
Typical High
$6.46