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Ostomy Pouch, Drainable, High Output, Two-Piece, No Filter

Arizona rates for HCPCS A4412

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), without filter, each

Rates data updated July 2026.

Facilitymedian $4 · 10th–90th $1$80%10%10th90th$4Professionalmedian $2 · 10th–90th $1$40%10%20%10th90th$2$0.1$0.2$1.0$5.0$20.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$2.29
Typical High
$3.31
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1.07
Median
$4.27
Typical High
$8.32
BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.95
Median
$3.98
Typical High
$7.94
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$2.29
Typical High
$2.29
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$1.95
Typical High
$2.29
Medica
Setting
Facility
Modifier
Global
Typical Low
$1.05
Median
$2.82
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$1.26
Median
$1.58
Typical High
$18.62
United
Setting
Facility
Modifier
Global
Typical Low
$1.23
Median
$1.51
Typical High
$3.89
United
Setting
Professional
Modifier
Global
Typical Low
$1.26
Median
$1.58
Typical High
$2.40