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Ostomy Pouch, Urinary, with Faceplate Attached, Plastic

South Dakota rates for HCPCS A4379

Ostomy pouch, urinary, with faceplate attached, plastic, each

Rates data updated July 2026.

Facilitymedian $22 · 10th–90th $14$290%20%10th90th$22Professionalmedian $19 · 10th–90th $13$300%10%10th90th$19$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$15.14
Median
$15.14
Typical High
$15.14
Aetna
Setting
Professional
Modifier
Global
Typical Low
$13.49
Median
$14.45
Typical High
$28.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$13.80
Typical High
$23.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$24.55
Typical High
$30.20
Medica
Setting
Facility
Modifier
Global
Typical Low
$14.45
Median
$22.91
Typical High
$38.90
Medica
Setting
Professional
Modifier
Global
Typical Low
$8.32
Median
$13.49
Typical High
$104.71
Midlands
Setting
Professional
Modifier
Global
Typical Low
$19.05
Median
$22.91
Typical High
$22.91
Midlands
Setting
Facility
Modifier
Global
Typical Low
$23.44
Median
$23.44
Typical High
$23.44
Midlands
Setting
Professional
Modifier
Global
Typical Low
$19.05
Median
$19.05
Typical High
$38.02
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$20.89
Typical High
$27.54
United
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$9.77
Typical High
$14.79
United
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$13.80
Typical High
$24.55
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$16.98
Median
$16.98
Typical High
$16.98