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Ostomy Pouch, Urinary, One-Piece, Standard Wear, Convex

South Dakota rates for HCPCS A4392

Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (one piece), each

Rates data updated July 2026.

Facilitymedian $12 · 10th–90th $7$150%10%20%10th90th$12Professionalmedian $10 · 10th–90th $7$170%10%20%10th90th$10$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
$8.32
Median
$8.32
Typical High
$8.32
Aetna
Setting
Professional
Modifier
Global
Typical Low
$7.24
Median
$7.76
Typical High
$15.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$12.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$13.18
Typical High
$16.60
Medica
Setting
Facility
Modifier
Global
Typical Low
$7.76
Median
$12.30
Typical High
$21.38
Medica
Setting
Professional
Modifier
Global
Typical Low
$4.57
Median
$7.24
Typical High
$56.23
Midlands
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$12.59
Typical High
$12.59
Midlands
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$12.88
Midlands
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$10.47
Typical High
$20.42
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$11.48
Typical High
$15.14
United
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$5.37
Typical High
$8.13
United
Setting
Professional
Modifier
Global
Typical Low
$3.80
Median
$7.59
Typical High
$13.49
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$9.33
Typical High
$9.33