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

Pennsylvania 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 $2$190%50%10th90th$2Professionalmedian $2 · 10th–90th $2$40%50%10th90th$2$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
$1.86
Median
$1.86
Typical High
$2.95
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.66
Median
$2.29
Typical High
$3.55
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$3.80
Median
$3.80
Typical High
$3.80
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$2.29
Typical High
$8.71
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$1.95
Typical High
$2.34
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$3.55
Median
$5.01
Typical High
$7.41
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$3.89
Median
$3.89
Typical High
$3.89
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$2.29
Median
$2.69
Typical High
$3.89
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$1.86
Median
$1.86
Typical High
$2.95
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$1.66
Median
$2.29
Typical High
$3.16
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$2.00
Median
$2.00
Typical High
$2.00
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$3.47
Median
$3.47
Typical High
$3.47
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$3.63
Median
$13.49
Typical High
$21.88
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$2.69
Median
$3.63
Typical High
$3.63
United
Setting
Facility
Modifier
Global
Typical Low
$1.26
Median
$1.74
Typical High
$2.40
United
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$1.86
Typical High
$3.89