go back

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

Utah 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 $1 · 10th–90th $1$20%50%90th$1Professionalmedian $3 · 10th–90th $1$170%10%20%10th90th$3$0.0$0.1$0.5$2.0$10.0$50.0

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
$1.05
Median
$1.05
Typical High
$1.05
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.05
Median
$2.45
Typical High
$16.60
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$2.29
Typical High
$2.29
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$1.95
Typical High
$2.69
Molina
Setting
Professional
Modifier
Global
Typical Low
$2.24
Median
$2.75
Typical High
$3.72
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$2.09
Median
$2.69
Typical High
$4.27
Select Health
Setting
Facility
Modifier
Global
Typical Low
$3.89
Median
$3.89
Typical High
$3.89
Select Health
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$3.89
Typical High
$3.89
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$2.88
Median
$3.89
Typical High
$4.68
United
Setting
Facility
Modifier
Global
Typical Low
$1.26
Median
$1.48
Typical High
$1.58
United
Setting
Professional
Modifier
Global
Typical Low
$1.26
Median
$1.58
Typical High
$2.88