Assura Original 1-piece closed
ColoplastPouches1-pieceClosedFlat
- Brand
- Coloplast
- Category
- Pouches
- System
- 1-piece
- Pouch type
- Closed
- Barrier type
- Flat (from product name)
- Opening
- Not found in our sources
- Filter
- Yes
- Box quantity
- 30
- Flange sizes
- Not found in our sources
- HCPCS code(s)
- A4416 (Coloplast product page (variant name))
- Lowest cash price seen
- From $78.16 / Box of 30 ($2.61 each)
Vitality Medical, Nov 4, 2026 - Source
- products.coloplast.us · 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 |
|---|---|---|---|---|
12110 | Mini (5in / 170mL) - Stoma size: 20-65mm | 13/16 - 2 1/2in - with filter - Opaque | 30 per box | A4416 | $96.17 / Box of 30 Vitality Medical · Nov 4, 2026 |
12130 | Midi (7in / 350mL) - Stoma size: 20-65mm | 13/16 - 2 1/2in - with filter Transparent | 30 per box | A4416 | $104.10 / Box of 30 Vitality Medical · Nov 4, 2026 |
12134 | Midi (7in / 350mL) - Stoma size: 25mm | 1in - with filter, Transparent | 30 per box | A4416 | $104.10 / Box of 30 Vitality Medical · Nov 4, 2026 |
12135 | Midi (7in / 350mL) - Stoma size: 30mm | 1 3/16in - with filter Transparent | 30 per box | A4416 | $104.10 / Box of 30 Vitality Medical · Nov 4, 2026 |
12136 | Midi (7in / 350mL) - Stoma size: 35mm | 1 3/8in - with filter, Transparent | 30 per box | A4416 | $104.10 / Box of 30 Vitality Medical · Nov 4, 2026 |
12140 | Midi (7in / 350mL) - Stoma size: 20-65mm | 13/16 - 2 1/2in - with filter Opaque | 30 per box | A4416 | $108.55 / Box of 30 Vitality Medical · Nov 4, 2026 |
12144 | Midi (7in / 350mL) - Stoma size: 25mm | 1in - with filter, Opaque | 30 per box | A4416 | $78.16 / Box of 30 Vitality Medical · Nov 4, 2026 |
12145 | Midi (7in / 350mL) - Stoma size: 30mm | 1 3/16in - with filter, Opaque | 30 per box | A4416 | $104.08 / Box of 30 Vitality Medical · Nov 4, 2026 |
12146 | Midi (7in / 350mL) - Stoma size: 35mm | 1 3/8in - with filter Opaque | 30 per box | A4416 | $104.10 / Box of 30 Vitality Medical · Nov 4, 2026 |
12147 | Midi (7in / 350mL) - Stoma size: 40mm | 1 9/16in - with filter Opaque | 30 per box | A4416 | $96.62 / Box of 30 Vitality Medical · Nov 4, 2026 |
12149 | Midi (7in / 350mL) - Stoma size: 50mm | 2in - with filter, Opaque | 30 per box | A4416 | $101.94 / Box of 30 Vitality Medical · Nov 4, 2026 |
12170 | Maxi (8 1/2in / 530mL) - Stoma size: 20-75mm | 13/16 - 3in - with filter Opaque | 30 per box | A4416 | $96.17 / Box of 30 Vitality Medical · Nov 4, 2026 |
12174 | Maxi (8 1/2in / 530mL) - Stoma size: 25mm | 1in - with filter, Opaque | 30 per box | A4416 | $104.10 / Box of 30 Vitality Medical · Nov 4, 2026 |
12175 | Maxi (8 1/2in / 530mL) - Stoma size: 30mm | 1 3/16in - with filter, Opaque | 30 per box | A4416 | $95.51 / Box of 30 Vitality Medical · Nov 4, 2026 |
12176 | Maxi (8 1/2in / 530mL) - Stoma size: 35mm | 1 3/8in - with filter Opaque | 30 per box | A4416 | $101.94 / Box of 30 Vitality Medical · Nov 4, 2026 |
12177 | Maxi (8 1/2in / 530mL) - Stoma size: 40mm | 1 9/16in - with filter Opaque | 30 per box | A4416 | $96.62 / Box of 30 Vitality Medical · Nov 4, 2026 |
Medicare usual maximums for these codes
- A4416: Ostomy pouch, closed, with barrier attached, with filter (1 piece), each. Usual maximum in LCD L33828: 60 per month.
From our Medicare guide (LCD L33828). Informational only; coverage depends on your plan and documentation. Confirm with your supplier or plan.
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