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

Vermont 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 $1$30%20%10th90th$2Professionalmedian $3 · 10th–90th $2$40%20%10th90th$3$2.0$5.0$10.0

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
Professional
Modifier
Global
Typical Low
$2.00
Median
$2.57
Typical High
$3.55
BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.09
Median
$3.09
Typical High
$3.09
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
$2.34
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$2.95
Median
$2.95
Typical High
$3.72
United
Setting
Facility
Modifier
Global
Typical Low
$1.26
Median
$1.32
Typical High
$1.74
United
Setting
Professional
Modifier
Global
Typical Low
$1.35
Median
$2.34
Typical High
$7.59