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Ostomy Pouch, Urinary, for Use on Faceplate, Plastic

South Dakota rates for HCPCS A4381

Ostomy pouch, urinary, for use on faceplate, plastic, each

Rates data updated July 2026.

Facilitymedian $7 · 10th–90th $4$90%20%10th90th$7Professionalmedian $6 · 10th–90th $4$90%10%10th90th$6$2.0$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
$4.68
Median
$4.68
Typical High
$4.68
Aetna
Setting
Professional
Modifier
Global
Typical Low
$4.07
Median
$4.47
Typical High
$8.71
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.89
Median
$3.89
Typical High
$7.24
Cigna
Setting
Professional
Modifier
Global
Typical Low
$7.59
Median
$7.59
Typical High
$9.33
Medica
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$7.08
Typical High
$12.02
Medica
Setting
Professional
Modifier
Global
Typical Low
$2.57
Median
$4.07
Typical High
$32.36
Midlands
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$7.08
Typical High
$7.08
Midlands
Setting
Facility
Modifier
Global
Typical Low
$7.24
Median
$7.24
Typical High
$7.24
Midlands
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$11.48
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$5.37
Median
$6.46
Typical High
$8.51
United
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$3.02
Typical High
$4.57
United
Setting
Professional
Modifier
Global
Typical Low
$2.14
Median
$4.27
Typical High
$7.59
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$5.25
Median
$5.25
Typical High
$5.25