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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 October 2026.

How much does Ostomy Pouch, Drainable, High Output, Two-Piece, No Filter cost?

$2.00

Typical negotiated rate. In New Hampshire, October 2026.

Insurers have agreed to pay about $2.00 for this service. Most negotiated rates run $1.91 to $2.00.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $2 · 10th to 90th $2 to $4Professionalmedian $2 · 10th to 90th $2 to $3
$2$5facility $2professional $2

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$1.66
Median
$2.00
Typical High
$2.00
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$1.91
Median
$2.00
Typical High
$2.00
Anthem BCBS
Setting
Professional
Modifier
RR · Rental
Typical Low
$0.19
Median
$0.19
Typical High
$0.19
Anthem BCBS
Setting
Professional
Modifier
UE · Used equipment
Typical Low
$1.41
Median
$1.41
Typical High
$1.41
Cigna
Setting
Facility
Modifier
None
Typical Low
$2.29
Median
$2.29
Typical High
$2.82
Cigna
Setting
Professional
Modifier
None
Typical Low
$1.95
Median
$1.95
Typical High
$2.29
Harvard Pilgrim
Setting
Professional
Modifier
None
Typical Low
$1.48
Median
$3.31
Typical High
$5.37
United
Setting
Professional
Modifier
None
Typical Low
$1.26
Median
$1.86
Typical High
$3.09
Well Sense
Setting
Facility
Modifier
None
Typical Low
$3.80
Median
$3.80
Typical High
$3.80

Where New Hampshire sits

The same service costs 2.2 times more in Kansas than in Alabama. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

New Hampshire· 44th of 51

$2.00

KS $4.37AL $1.95

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.