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

Oregon 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 $4 · 10th–90th $3$40%50%10th90th$4Professionalmedian $3 · 10th–90th $1$40%10%10th90th$3$1.0$5.0$20.0$100.0

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
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.95
Typical High
$3.02
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
$1.95
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$2.88
Median
$7.41
Typical High
$8.51
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$2.69
Median
$3.09
Typical High
$3.98
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$2.82
Median
$3.47
Typical High
$4.27
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$3.39
Median
$3.72
Typical High
$3.80
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$3.80
Typical High
$3.80
Providence
Setting
Facility
Modifier
Global
Typical Low
$2.19
Median
$3.31
Typical High
$4.57
Providence
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$3.63
Typical High
$79.43
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$4.27
Typical High
$4.27
United
Setting
Facility
Modifier
Global
Typical Low
$1.23
Median
$1.48
Typical High
$2.40
United
Setting
Professional
Modifier
Global
Typical Low
$1.26
Median
$1.58
Typical High
$3.09