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

South Dakota rates for HCPCS A4393

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

Rates data updated October 2026.

How much does Ostomy Pouch, Urinary, One-Piece, Extended Wear, Convex cost?

$10.47

Typical negotiated rate. In South Dakota, October 2026.

Insurers have agreed to pay about $10.47 for this service. The price depends on where it is billed: about $10.47 from a physician practice, and about $14.45 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$10.47$8.32 to $13.80
FacilityA hospital or hospital-owned outpatient department$14.45$9.12 to $14.45

How much rates vary

Facilitymedian $14 · 10th to 90th $9 to $23Professionalmedian $10 · 10th to 90th $5 to $17
$5$10$20$50facility $14professional $10

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$9.12
Median
$9.12
Typical High
$9.12
Aetna
Setting
Professional
Modifier
None
Typical Low
$8.71
Median
$8.71
Typical High
$9.33
Cigna
Setting
Facility
Modifier
None
Typical Low
$7.59
Median
$7.59
Typical High
$14.13
Cigna
Setting
Professional
Modifier
None
Typical Low
$13.80
Median
$14.79
Typical High
$18.20
Medica
Setting
Facility
Modifier
None
Typical Low
$8.71
Median
$14.45
Typical High
$23.44
Medica
Setting
Professional
Modifier
None
Typical Low
$5.01
Median
$7.24
Typical High
$63.10
Midlands
Setting
Professional
Modifier
None
Typical Low
$13.80
Median
$13.80
Typical High
$14.13
Midlands
Setting
Professional
Modifier
None
Typical Low
$11.48
Median
$11.48
Typical High
$22.91
Sanford Health Plan
Setting
Professional
Modifier
None
Typical Low
$10.96
Median
$12.59
Typical High
$14.79
United
Setting
Professional
Modifier
None
Typical Low
$4.47
Median
$5.89
Typical High
$9.55
Wellmark
Setting
Professional
Modifier
None
Typical Low
$10.23
Median
$10.23
Typical High
$10.23

Where South Dakota sits

The same service costs 2.1 times more in Idaho than in Connecticut. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

South Dakota· 15th of 51

$10.47

ID $13.49CT $6.46

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.