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

Washington 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$70%50%10th90th$4Professionalmedian $3 · 10th–90th $2$70%20%10th90th$3$0.1$0.2$1.0$5.0$20.0

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
$2.14
Median
$2.14
Typical High
$5.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$2.14
Typical High
$16.60
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$3.31
Median
$3.31
Typical High
$3.31
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$3.31
Typical High
$4.27
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$2.45
Typical High
$2.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$1.95
Typical High
$2.29
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$4.27
Typical High
$8.13
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$2.29
Median
$4.68
Typical High
$7.94
Molina
Setting
Professional
Modifier
Global
Typical Low
$2.63
Median
$2.88
Typical High
$64.57
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$3.39
Median
$3.72
Typical High
$3.80
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$3.80
Typical High
$4.68
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$3.16
Median
$3.31
Typical High
$6.17
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.16
Median
$3.16
Typical High
$3.72
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$3.09
Median
$3.31
Typical High
$4.27
United
Setting
Facility
Modifier
Global
Typical Low
$1.45
Median
$1.58
Typical High
$2.14
United
Setting
Professional
Modifier
Global
Typical Low
$1.48
Median
$1.74
Typical High
$3.09
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$1.91
Median
$3.31
Typical High
$5.75