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

New Mexico 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$40%10%10th90th$2Professionalmedian $2 · 10th–90th $1$40%10%20%10th90th$2$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
$2.75
Median
$2.75
Typical High
$2.75
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$2.69
Typical High
$16.60
BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.29
Median
$3.02
Typical High
$3.63
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
$5.75
Molina
Setting
Professional
Modifier
Global
Typical Low
$3.02
Median
$3.80
Typical High
$6.61
Providence
Setting
Facility
Modifier
Global
Typical Low
$1.05
Median
$2.69
Typical High
$4.90
Providence
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$1.95
Typical High
$3.98
United
Setting
Facility
Modifier
Global
Typical Low
$1.48
Median
$1.62
Typical High
$3.89
United
Setting
Professional
Modifier
Global
Typical Low
$1.48
Median
$1.58
Typical High
$2.40