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

Hawaii 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 $1 · 10th–90th $1$30%20%10th90th$1Professionalmedian $4 · 10th–90th $2$40%20%40%10th90th$4$2.0$5.0

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
Professional
Modifier
Global
Typical Low
$1.86
Median
$1.86
Typical High
$2.14
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$2.82
Typical High
$3.02
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.29
Median
$3.55
Typical High
$4.79
HMSA
Setting
Professional
Modifier
Global
Typical Low
$3.89
Median
$3.89
Typical High
$4.07
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$2.29
Median
$3.89
Typical High
$5.37
United
Setting
Facility
Modifier
Global
Typical Low
$1.23
Median
$1.26
Typical High
$1.48
United
Setting
Professional
Modifier
Global
Typical Low
$1.70
Median
$2.69
Typical High
$4.68