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Ostomy Pouch, Urinary, for Use on Faceplate, Rubber

South Dakota rates for HCPCS A4383

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

Rates data updated July 2026.

Facilitymedian $42 · 10th–90th $26$540%10%20%10th90th$42Professionalmedian $36 · 10th–90th $25$580%20%10th90th$36$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
$28.84
Median
$28.84
Typical High
$28.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$26.92
Typical High
$53.70
Cigna
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$26.30
Typical High
$44.67
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$57.54
Medica
Setting
Facility
Modifier
Global
Typical Low
$26.92
Median
$42.66
Typical High
$74.13
Medica
Setting
Professional
Modifier
Global
Typical Low
$15.85
Median
$25.12
Typical High
$194.98
Midlands
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$43.65
Typical High
$43.65
Midlands
Setting
Facility
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$44.67
Midlands
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$36.31
Typical High
$70.79
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$39.81
Typical High
$52.48
United
Setting
Facility
Modifier
Global
Typical Low
$15.14
Median
$18.62
Typical High
$27.54
United
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$26.30
Typical High
$45.71
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$32.36