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Ostomy Pouch, Urinary, Extended Wear Barrier, Faucet Tap

Montana 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 $9 · 10th–90th $6$110%20%40%10th90th$9Professionalmedian $8 · 10th–90th $3$400%10%20%10th90th$8$5.0$10.0$20.0$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
Professional
Modifier
Global
Typical Low
$2.51
Median
$7.24
Typical High
$39.81
BCBS
Setting
Professional
Modifier
Global
Typical Low
$8.91
Median
$8.91
Typical High
$8.91
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$9.55
Typical High
$9.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$9.55
Typical High
$9.55
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$8.91
Typical High
$17.38
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$8.91
Typical High
$17.38
Providence
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$8.51
Typical High
$10.96
Providence
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$9.55
Typical High
$79.43
United
Setting
Facility
Modifier
Global
Typical Low
$3.09
Median
$3.55
Typical High
$3.55
United
Setting
Professional
Modifier
Global
Typical Low
$3.47
Median
$3.89
Typical High
$5.25