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

Maine 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$20%20%40%10th90th$2Professionalmedian $3 · 10th–90th $2$30%20%10th90th$3$1.0$2.0$5.0$10.0

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
$1.00
Median
$2.00
Typical High
$3.55
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.91
Median
$1.91
Typical High
$2.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$2.29
Typical High
$2.29
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$1.95
Typical High
$2.45
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$3.31
Typical High
$3.98
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$1.00
Median
$2.19
Typical High
$3.55
United
Setting
Facility
Modifier
Global
Typical Low
$1.02
Median
$1.45
Typical High
$2.04
United
Setting
Professional
Modifier
Global
Typical Low
$1.48
Median
$3.24
Typical High
$3.31