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Ostomy Pouch, Closed, One-Piece, Convex, with Filter

South Dakota rates for HCPCS A4417

Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (one piece), each

Rates data updated July 2026.

How much does Ostomy Pouch, Closed, One-Piece, Convex, with Filter cost?

$5.01

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $5.01 for this service. The price depends on where it is billed: about $4.79 from a physician practice, and about $5.50 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$4.79$3.55 to $6.03
FacilityA hospital or hospital-owned outpatient department$5.50$3.80 to $6.03

How much rates vary

Facilitymedian $5 · 10th to 90th $3 to $7Professionalmedian $5 · 10th to 90th $3 to $8
$2.0$5.0$10.0$20.0$50.0facility $5professional $5

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. 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
Global
Typical Low
$3.80
Median
$3.80
Typical High
$3.80
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$3.55
Typical High
$7.08
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.16
Median
$3.16
Typical High
$5.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$7.59
Medica
Setting
Facility
Modifier
Global
Typical Low
$3.55
Median
$5.62
Typical High
$9.77
Medica
Setting
Professional
Modifier
Global
Typical Low
$2.04
Median
$3.31
Typical High
$25.70
Midlands
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$5.75
Typical High
$5.75
Midlands
Setting
Facility
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$5.89
Midlands
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$4.79
Typical High
$9.33
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$4.37
Median
$5.25
Typical High
$6.92
United
Setting
Facility
Modifier
Global
Typical Low
$2.04
Median
$2.45
Typical High
$3.72
United
Setting
Professional
Modifier
Global
Typical Low
$1.74
Median
$3.47
Typical High
$6.17
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$4.27
Median
$4.27
Typical High
$4.27

Where South Dakota sits

The same service costs 2.1 times more in Hawaii than in Colorado. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

South Dakota $5.01 · 4th of 51
HI $5.37CO $2.57

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.