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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 July 2026.

Facilitymedian $13 · 10th–90th $8$170%10%20%10th90th$13Professionalmedian $11 · 10th–90th $8$180%10%20%10th90th$11$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
$9.12
Median
$9.12
Typical High
$9.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$8.71
Typical High
$16.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7.59
Median
$7.59
Typical High
$14.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$14.79
Median
$14.79
Typical High
$18.20
Medica
Setting
Facility
Modifier
Global
Typical Low
$8.71
Median
$13.80
Typical High
$23.44
Medica
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$8.13
Typical High
$63.10
Midlands
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$13.80
Typical High
$13.80
Midlands
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$14.13
Typical High
$14.13
Midlands
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$11.48
Typical High
$22.91
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$12.59
Typical High
$16.60
United
Setting
Facility
Modifier
Global
Typical Low
$4.90
Median
$5.89
Typical High
$8.91
United
Setting
Professional
Modifier
Global
Typical Low
$4.17
Median
$8.32
Typical High
$14.79
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$10.23
Median
$10.23
Typical High
$10.23