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New Image Two-Piece High Output Drainable Ostomy Pouch

Brand: Hollister
Category: Pouches
System: 2-piece
Pouch type: High output
Barrier type: Not found in our sources
Opening: Not found in our sources
Filter: Not found in our sources
Box quantity: 10
Flange sizes: Not found in our sources
HCPCS code(s): A4412 (Hollister product page)
Lowest cash price seen: From $63.35 / Box of 10 ($6.33 each)
Vitality Medical, Nov 4, 2026
Source: hollister.com · checked Nov 4, 2026

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Sizes, codes and prices

Prices are cash prices one retailer listed on the date shown, per the retailer's unit. Retailer links are marked as sponsored for search engines and may become affiliate links later. We do not take referral fees from suppliers that bill Medicare. The retailer page says the manufacturer labels this item Rx only.

Code	Description / size	Box	HCPCS	Price seen
`18012`	Green, 1 3/4 Inch Description from Vitality Medical listing	Box of 10	A4412	$68.95 / Box of 10 Vitality Medical · Nov 4, 2026
`18013`	Red, 2 1/4 Inch Description from Vitality Medical listing	Box of 10	A4412	$6.34 / Each Vitality Medical · Nov 4, 2026$63.35 / Box of 10 Vitality Medical · Nov 4, 2026
`18014`	Blue, 2 3/4 Inch Description from Vitality Medical listing	Box of 10	A4412	$68.95 / Box of 10 Vitality Medical · Nov 4, 2026
`18016`	Yellow, 4 Inch Description from Vitality Medical listing	Box of 10	A4412	$79.49 / Box of 10 Vitality Medical · Nov 4, 2026

Medicare usual maximums for these codes

A4412: Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each. No usual maximum is listed for this code in the LCD table.

From our Medicare guide (LCD L33828). Informational only; coverage depends on your plan and documentation. Confirm with your supplier or plan.