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

New Hampshire 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%50%10th90th$2Professionalmedian $2 · 10th–90th $2$30%20%10th90th$2$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$2.00
Median
$2.00
Typical High
$2.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.62
Median
$2.00
Typical High
$2.40
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.91
Median
$1.91
Typical High
$2.00
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
$2.69
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$3.31
Typical High
$6.17
United
Setting
Facility
Modifier
Global
Typical Low
$1.00
Median
$1.45
Typical High
$1.58
United
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$2.14
Typical High
$3.31
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$5.01
Median
$5.01
Typical High
$17.38