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

Ohio 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$40%20%10th90th$3Professionalmedian $2 · 10th–90th $2$40%10%20%10th90th$2$0.0$0.1$0.5$2.0$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
$2.40
Median
$3.16
Typical High
$3.98
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.09
Median
$2.40
Typical High
$3.24
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$3.02
Median
$3.02
Typical High
$3.09
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.91
Median
$2.29
Typical High
$5.01
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$3.89
Median
$3.89
Typical High
$3.89
CareSource
Setting
Facility
Modifier
Global
Typical Low
$1.91
Median
$3.24
Typical High
$4.57
CareSource
Setting
Professional
Modifier
Global
Typical Low
$2.45
Median
$3.39
Typical High
$5.13
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
$2.45
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$2.29
Typical High
$2.51
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$1.95
Typical High
$2.45
Molina
Setting
Professional
Modifier
Global
Typical Low
$1.74
Median
$2.45
Typical High
$3.55
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$3.89
Median
$4.37
Typical High
$7.94
United
Setting
Facility
Modifier
Global
Typical Low
$1.20
Median
$1.74
Typical High
$3.89
United
Setting
Professional
Modifier
Global
Typical Low
$1.23
Median
$1.82
Typical High
$2.69