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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 October 2026.

How much does Ostomy Pouch, Drainable, High Output, Two-Piece, No Filter cost?

$2.09

Typical negotiated rate. In Utah, October 2026.

Insurers have agreed to pay about $2.09 for this service. The price depends on where it is billed: about $2.14 from a physician practice, and about $1.05 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$2.14$1.55 to $2.69
FacilityA hospital or hospital-owned outpatient department$1.05$1.05 to $2.29

How much rates vary

Facilitymedian $1 · 10th to 90th $1 to $2Professionalmedian $2 · 10th to 90th $1 to $4
$1$2$5$10$20$50facility $1professional $2

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$1.05
Median
$1.05
Typical High
$1.05
Aetna
Setting
Professional
Modifier
None
Typical Low
$1.05
Median
$1.05
Typical High
$1.17
Cigna
Setting
Facility
Modifier
None
Typical Low
$2.29
Median
$2.29
Typical High
$2.45
Cigna
Setting
Professional
Modifier
None
Typical Low
$1.95
Median
$1.95
Typical High
$2.29
Molina
Setting
Professional
Modifier
None
Typical Low
$2.75
Median
$2.75
Typical High
$60.26
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$2.69
Median
$2.69
Typical High
$2.69
Select Health
Setting
Facility
Modifier
None
Typical Low
$3.89
Median
$3.89
Typical High
$3.89
Select Health
Setting
Professional
Modifier
None
Typical Low
$1.95
Median
$3.89
Typical High
$3.89
U of Utah Health Plan
Setting
Professional
Modifier
None
Typical Low
$2.45
Median
$3.31
Typical High
$5.50
United
Setting
Professional
Modifier
None
Typical Low
$1.26
Median
$1.58
Typical High
$3.16

Where Utah sits

The same service costs 2.2 times more in Kansas than in Alabama. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Utah· 38th of 51

$2.09

KS $4.37AL $1.95

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.