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Ostomy Pouch, Urinary, Extended Wear Barrier, Faucet Tap

Pennsylvania 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 $5 · 10th–90th $4$450%20%40%10th90th$5Professionalmedian $6 · 10th–90th $4$90%20%40%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
$4.47
Median
$4.47
Typical High
$7.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$5.62
Typical High
$8.71
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$9.12
Median
$9.12
Typical High
$9.12
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$12.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$4.68
Typical High
$5.62
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$10.23
Typical High
$17.78
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$9.33
Median
$9.33
Typical High
$9.33
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$5.62
Median
$6.46
Typical High
$9.33
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.31
Median
$6.76
Typical High
$6.76
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$4.47
Typical High
$7.08
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$5.62
Typical High
$7.59
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$4.79
Median
$4.79
Typical High
$4.79
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$8.71
Median
$33.11
Typical High
$58.88
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$8.71
Typical High
$8.71
United
Setting
Facility
Modifier
Global
Typical Low
$3.09
Median
$4.17
Typical High
$5.75
United
Setting
Professional
Modifier
Global
Typical Low
$3.24
Median
$4.57
Typical High
$9.77