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Ostomy Pouch, Urinary, Extended Wear Barrier, Faucet Tap

Texas 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 $8 · 10th–90th $5$250%20%10th90th$8Professionalmedian $5 · 10th–90th $4$80%20%10th90th$5$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

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
$4.57
Median
$5.89
Typical High
$6.46
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$5.89
Typical High
$7.94
BCBS
Setting
Facility
Modifier
Global
Typical Low
$7.08
Median
$9.12
Typical High
$25.12
BCBS
Setting
Professional
Modifier
Global
Typical Low
$4.37
Median
$4.37
Typical High
$4.90
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$5.62
Median
$7.41
Typical High
$11.22
Christus
Setting
Facility
Modifier
Global
Typical Low
$9.33
Median
$9.33
Typical High
$79.43
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$6.17
Cigna
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$4.68
Typical High
$5.50
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$85.11
Typical High
$85.11
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$67.61
Typical High
$67.61
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$4.57
Median
$7.59
Typical High
$12.88
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$5.62
Median
$7.94
Typical High
$9.33
Molina
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$6.76
Typical High
$81.28
Providence
Setting
Facility
Modifier
Global
Typical Low
$4.57
Median
$7.24
Typical High
$12.88
Providence
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$4.68
Typical High
$5.75
United
Setting
Facility
Modifier
Global
Typical Low
$3.02
Median
$4.17
Typical High
$9.33
United
Setting
Professional
Modifier
Global
Typical Low
$3.24
Median
$4.17
Typical High
$5.50
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$4.57
Median
$9.33
Typical High
$12.59