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

Illinois 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$200%20%10th90th$4Professionalmedian $3 · 10th–90th $2$40%20%10th90th$3$0.0$0.1$0.5$2.0$10.0$50.0$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
$2.14
Median
$2.14
Typical High
$3.89
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.78
Median
$2.34
Typical High
$3.89
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$2.51
BCBS
Setting
Facility
Modifier
Global
Typical Low
$6.31
Median
$10.96
Typical High
$33.11
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$2.88
Typical High
$2.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$2.29
Typical High
$4.27
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$1.95
Typical High
$4.17
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$3.39
Median
$8.91
Typical High
$12.59
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$4.90
Median
$4.90
Typical High
$4.90
Molina
Setting
Professional
Modifier
Global
Typical Low
$3.63
Median
$3.63
Typical High
$3.63
United
Setting
Facility
Modifier
Global
Typical Low
$1.20
Median
$3.89
Typical High
$3.89
United
Setting
Professional
Modifier
Global
Typical Low
$1.35
Median
$1.86
Typical High
$3.31