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Ostomy Pouch, Urinary, Extended Wear Barrier, Faucet Tap

Utah 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 $3 · 10th–90th $3$50%50%90th$3Professionalmedian $6 · 10th–90th $3$400%10%10th90th$6$0.1$0.5$2.0$10.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$2.51
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$5.89
Typical High
$39.81
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
$6.46
Molina
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$6.61
Typical High
$8.91
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$6.46
Typical High
$10.23
Select Health
Setting
Facility
Modifier
Global
Typical Low
$9.33
Median
$9.33
Typical High
$9.33
Select Health
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$9.33
Typical High
$9.33
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$9.33
Typical High
$11.22
United
Setting
Facility
Modifier
Global
Typical Low
$3.09
Median
$3.55
Typical High
$3.89
United
Setting
Professional
Modifier
Global
Typical Low
$3.02
Median
$3.89
Typical High
$6.92