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

South Dakota 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 $2$50%20%10th90th$4Professionalmedian $4 · 10th–90th $2$60%10%10th90th$4$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. Small sample; interpret with caution. 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
$2.40
Median
$2.57
Typical High
$5.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$2.29
Typical High
$4.27
Cigna
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$4.47
Typical High
$5.62
Medica
Setting
Facility
Modifier
Global
Typical Low
$2.57
Median
$4.07
Typical High
$7.08
Medica
Setting
Professional
Modifier
Global
Typical Low
$1.51
Median
$2.40
Typical High
$18.62
Midlands
Setting
Professional
Modifier
Global
Typical Low
$3.47
Median
$4.17
Typical High
$4.17
Midlands
Setting
Facility
Modifier
Global
Typical Low
$4.27
Median
$4.27
Typical High
$4.27
Midlands
Setting
Professional
Modifier
Global
Typical Low
$3.47
Median
$3.47
Typical High
$6.76
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$3.16
Median
$3.80
Typical High
$5.01
United
Setting
Facility
Modifier
Global
Typical Low
$1.48
Median
$1.78
Typical High
$2.69
United
Setting
Professional
Modifier
Global
Typical Low
$1.26
Median
$2.51
Typical High
$4.47
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$3.09
Median
$3.09
Typical High
$3.09