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

Virginia 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$60%20%10th90th$3Professionalmedian $2 · 10th–90th $2$40%20%10th90th$2$0.0$0.2$2.0$20.0$200.0$2.0K

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
$2.34
Median
$2.34
Typical High
$2.57
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.62
Median
$2.34
Typical High
$2.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.91
Median
$1.91
Typical High
$3.98
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$2.57
Median
$2.57
Typical High
$2.63
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
$1.95
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$2.88
Median
$3.89
Typical High
$5.37
Medcost
Setting
Professional
Modifier
Global
Typical Low
$1.91
Median
$2.57
Typical High
$2.57
Medcost
Setting
Facility
Modifier
Global
Typical Low
$1.62
Median
$2.75
Typical High
$4.57
Medcost
Setting
Professional
Modifier
Global
Typical Low
$2.04
Median
$2.34
Typical High
$2.51
Sentara
Setting
Facility
Modifier
Global
Typical Low
$2.57
Median
$3.39
Typical High
$13.18
Sentara
Setting
Professional
Modifier
Global
Typical Low
$2.57
Median
$3.39
Typical High
$13.18
United
Setting
Facility
Modifier
Global
Typical Low
$1.07
Median
$1.48
Typical High
$1.95
United
Setting
Professional
Modifier
Global
Typical Low
$1.58
Median
$1.86
Typical High
$3.02