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

Idaho 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 $2$60%20%10th90th$4Professionalmedian $3 · 10th–90th $1$50%10%20%10th90th$3$1.0$2.0$5.0$10.0$20.0

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
$2.57
Typical High
$5.13
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2.75
Median
$3.63
Typical High
$6.17
BCBS
Setting
Professional
Modifier
Global
Typical Low
$4.07
Median
$4.27
Typical High
$4.27
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$2.29
Typical High
$2.45
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$1.95
Typical High
$2.69
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$1.05
Median
$3.63
Typical High
$5.62
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$3.16
Median
$3.63
Typical High
$3.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$2.69
Median
$2.69
Typical High
$30.20
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$2.69
Median
$2.69
Typical High
$4.27
Select Health
Setting
Facility
Modifier
Global
Typical Low
$3.89
Median
$3.89
Typical High
$5.75
Select Health
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$3.63
Typical High
$4.27
United
Setting
Facility
Modifier
Global
Typical Low
$1.26
Median
$1.48
Typical High
$2.40
United
Setting
Professional
Modifier
Global
Typical Low
$1.48
Median
$1.58
Typical High
$2.04