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Ostomy Pouch, Urinary, Extended Wear Barrier, Faucet Tap

New York 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 $7 · 10th–90th $4$130%20%10th90th$7Professionalmedian $6 · 10th–90th $4$130%20%10th90th$6$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$5.62
Typical High
$10.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.80
Median
$5.62
Typical High
$8.71
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$6.92
Typical High
$12.88
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$7.08
Median
$7.59
Typical High
$7.59
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$7.59
Median
$7.59
Typical High
$7.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.75
Typical High
$12.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$4.68
Typical High
$6.46
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$9.33
Median
$15.49
Typical High
$35.48
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$9.33
Typical High
$17.78
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$7.24
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$6.92
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$14.79
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$5.62
Median
$8.91
Typical High
$10.47
United
Setting
Facility
Modifier
Global
Typical Low
$3.24
Median
$3.89
Typical High
$25.70
United
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$6.03
Typical High
$15.49
Univera
Setting
Facility
Modifier
Global
Typical Low
$6.46
Median
$6.61
Typical High
$7.24
Univera
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$6.92