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

Nebraska 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$790%20%10th90th$4Professionalmedian $2 · 10th–90th $1$30%20%40%10th90th$2$0.0$0.1$0.5$2.0$10.0$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
$3.16
Median
$3.16
Typical High
$3.16
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.15
Median
$2.45
Typical High
$3.16
BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$3.63
Typical High
$3.72
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$2.82
Typical High
$4.27
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.29
Median
$4.47
Typical High
$7.94
Medica
Setting
Facility
Modifier
Global
Typical Low
$3.09
Median
$5.37
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$1.26
Median
$1.86
Typical High
$3.98
Midlands
Setting
Professional
Modifier
Global
Typical Low
$4.17
Median
$4.17
Typical High
$10.23
Midlands
Setting
Facility
Modifier
Global
Typical Low
$4.27
Median
$4.27
Typical High
$4.27
Midlands
Setting
Professional
Modifier
Global
Typical Low
$5.25
Median
$9.33
Typical High
$10.23
United
Setting
Facility
Modifier
Global
Typical Low
$1.35
Median
$2.29
Typical High
$3.89
United
Setting
Professional
Modifier
Global
Typical Low
$1.26
Median
$1.82
Typical High
$2.95