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Ostomy Pouch, Urinary, Extended Wear Barrier, Faucet Tap

South Dakota 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 $5$130%20%10th90th$10Professionalmedian $8 · 10th–90th $6$130%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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$6.61
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$6.17
Typical High
$12.30
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$10.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$10.47
Typical High
$13.18
Medica
Setting
Facility
Modifier
Global
Typical Low
$6.17
Median
$10.00
Typical High
$16.98
Medica
Setting
Professional
Modifier
Global
Typical Low
$3.63
Median
$5.75
Typical High
$45.71
Midlands
Setting
Professional
Modifier
Global
Typical Low
$8.32
Median
$10.00
Typical High
$10.00
Midlands
Setting
Facility
Modifier
Global
Typical Low
$10.23
Median
$10.23
Typical High
$10.23
Midlands
Setting
Professional
Modifier
Global
Typical Low
$8.32
Median
$8.32
Typical High
$16.22
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$7.59
Median
$9.12
Typical High
$12.02
United
Setting
Facility
Modifier
Global
Typical Low
$3.55
Median
$4.27
Typical High
$6.46
United
Setting
Professional
Modifier
Global
Typical Low
$3.02
Median
$6.03
Typical High
$10.72
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$7.41
Median
$7.41
Typical High
$7.41