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

Massachusetts 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 $3 · 10th–90th $2$790%20%10th90th$3Professionalmedian $3 · 10th–90th $2$50%20%40%10th90th$3$1.0$10.0$100.0$1.0K$10.0K

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
$1.66
Median
$1.66
Typical High
$1.66
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.66
Median
$2.00
Typical High
$7.59
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$3.63
Median
$3.72
Typical High
$79.43
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$1.48
Median
$3.09
Typical High
$4.57
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
$2.82
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$3,630.78
Typical High
$9,772.37
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$3.31
Typical High
$5.01
Health New England
Setting
Professional
Modifier
Global
Typical Low
$2.14
Median
$2.14
Typical High
$2.14
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$3.63
Median
$3.72
Typical High
$79.43
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$1.48
Median
$3.09
Typical High
$4.57
United
Setting
Facility
Modifier
Global
Typical Low
$1.23
Median
$1.58
Typical High
$3.89
United
Setting
Professional
Modifier
Global
Typical Low
$1.48
Median
$3.16
Typical High
$3.39