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Ostomy Pouch, Urinary, Extended Wear Barrier, Faucet Tap

Oregon 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 $7$90%50%10th90th$9Professionalmedian $7 · 10th–90th $3$100%10%10th90th$7$5.0$10.0$20.0$50.0$100.0$200.0$500.0

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
$2.69
Median
$4.68
Typical High
$7.41
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$5.50
Cigna
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$4.68
Typical High
$4.68
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$16.98
Typical High
$19.50
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$6.46
Median
$7.41
Typical High
$9.55
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$7.41
Typical High
$10.23
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.91
Typical High
$9.12
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$9.12
Typical High
$10.00
Providence
Setting
Facility
Modifier
Global
Typical Low
$5.25
Median
$7.94
Typical High
$10.96
Providence
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$8.71
Typical High
$79.43
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$7.94
Median
$10.23
Typical High
$10.23
United
Setting
Facility
Modifier
Global
Typical Low
$2.95
Median
$3.55
Typical High
$5.75
United
Setting
Professional
Modifier
Global
Typical Low
$3.02
Median
$3.89
Typical High
$7.41