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

North Dakota 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$50%50%10th90th$3Professionalmedian $4 · 10th–90th $2$50%20%10th90th$4$1.0$2.0$5.0$10.0$20.0$50.0

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
$2.40
Median
$2.75
Typical High
$2.75
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$2.40
Typical High
$14.45
BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.16
Median
$4.17
Typical High
$4.57
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.82
Median
$2.82
Typical High
$2.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.82
Median
$4.47
Typical High
$5.62
Medica
Setting
Facility
Modifier
Global
Typical Low
$1.82
Median
$2.75
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$1.48
Median
$1.78
Typical High
$3.80
United
Setting
Facility
Modifier
Global
Typical Low
$1.74
Median
$1.74
Typical High
$1.74
United
Setting
Professional
Modifier
Global
Typical Low
$1.35
Median
$2.29
Typical High
$4.47