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

Tennessee 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$850%20%40%10th90th$3Professionalmedian $2 · 10th–90th $2$30%20%10th90th$2$1.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1.95
Median
$2.19
Typical High
$3.39
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.66
Median
$2.40
Typical High
$3.31
BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.88
Median
$2.88
Typical High
$3.02
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$2.29
Typical High
$2.75
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$1.95
Typical High
$2.29
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$85.11
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$19.05
Median
$28.18
Typical High
$28.18
United
Setting
Facility
Modifier
Global
Typical Low
$1.45
Median
$1.74
Typical High
$3.89
United
Setting
Professional
Modifier
Global
Typical Low
$1.20
Median
$1.78
Typical High
$2.19