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Ostomy Pouch, Urinary, Extended Wear Barrier, Faucet Tap

Wisconsin 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 $8$170%20%40%10th90th$9Professionalmedian $9 · 10th–90th $5$160%10%20%10th90th$9$5.0$10.0$20.0$50.0$100.0

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
$5.25
Median
$5.25
Typical High
$5.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.25
Median
$5.25
Typical High
$7.94
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$9.33
Median
$9.33
Typical High
$15.49
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$8.71
Typical High
$10.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$28.84
Typical High
$46.77
Cigna
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$13.49
Typical High
$17.78
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$5.13
Median
$7.94
Typical High
$13.18
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$8.32
Median
$17.78
Typical High
$21.88
Medica
Setting
Facility
Modifier
Global
Typical Low
$5.25
Median
$9.12
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$3.89
Median
$4.57
Typical High
$10.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$33.11
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$14.79
Median
$14.79
Typical High
$14.79
Network Health
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$10.47
Typical High
$18.20
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$5.13
Median
$7.94
Typical High
$13.18
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$5.25
Median
$5.25
Typical High
$9.12
Quartz
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$13.80
Typical High
$22.91
Quartz
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$19.05
Typical High
$79.43
Quartz
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$13.80
Typical High
$46.77
Security Health
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$9.33
Typical High
$9.33
Security Health
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$9.33
Typical High
$9.33
United
Setting
Facility
Modifier
Global
Typical Low
$2.95
Median
$4.17
Typical High
$9.33
United
Setting
Professional
Modifier
Global
Typical Low
$3.02
Median
$4.57
Typical High
$7.76