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

New York 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$60%20%40%10th90th$3Professionalmedian $3 · 10th–90th $2$70%20%40%10th90th$3$0.0$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$1.62
Median
$2.29
Typical High
$4.37
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.58
Median
$2.29
Typical High
$3.55
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.00
Median
$3.39
Typical High
$7.08
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$2.95
Median
$3.16
Typical High
$3.16
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$3.16
Median
$3.16
Typical High
$3.16
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$2.82
Typical High
$8.71
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$1.95
Typical High
$2.82
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$3.89
Median
$6.31
Typical High
$14.79
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$4.79
Typical High
$7.41
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$2.88
Median
$2.88
Typical High
$3.02
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.75
Median
$2.75
Typical High
$2.88
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$6.17
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$2.34
Median
$3.72
Typical High
$4.37
United
Setting
Facility
Modifier
Global
Typical Low
$1.32
Median
$1.62
Typical High
$10.72
United
Setting
Professional
Modifier
Global
Typical Low
$1.35
Median
$2.51
Typical High
$6.61
Univera
Setting
Facility
Modifier
Global
Typical Low
$2.69
Median
$2.75
Typical High
$3.02
Univera
Setting
Professional
Modifier
Global
Typical Low
$2.75
Median
$2.75
Typical High
$2.88