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

California 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 $2 · 10th–90th $1$50%20%40%10th90th$2Professionalmedian $2 · 10th–90th $1$170%10%20%10th90th$2$0.0$0.2$2.0$20.0$200.0

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
Facility
Modifier
Global
Typical Low
$1.00
Median
$1.12
Typical High
$16.60
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$2.34
Typical High
$16.60
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1.41
Median
$1.82
Typical High
$4.47
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.91
Median
$2.00
Typical High
$7.08
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$3.98
Median
$5.25
Typical High
$7.94
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$3.63
Median
$6.76
Typical High
$14.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$2.29
Typical High
$2.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$1.95
Typical High
$2.34
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$3.09
Median
$3.98
Typical High
$5.25
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$2.29
Median
$3.47
Typical High
$6.31
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$85.11
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$19.05
Median
$28.18
Typical High
$28.18
Molina
Setting
Professional
Modifier
Global
Typical Low
$3.80
Median
$3.80
Typical High
$3.80
Providence
Setting
Facility
Modifier
Global
Typical Low
$1.10
Median
$3.80
Typical High
$5.13
Providence
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$1.95
Typical High
$3.72
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$7.08
Median
$7.08
Typical High
$7.08
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$3.09
Median
$4.47
Typical High
$7.59
United
Setting
Facility
Modifier
Global
Typical Low
$0.26
Median
$1.45
Typical High
$1.78
United
Setting
Professional
Modifier
Global
Typical Low
$1.45
Median
$1.70
Typical High
$3.98