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Ostomy Pouch, Drainable, Nonlocking Flange, with Filter

Utah rates for HCPCS A4425

Ostomy pouch, drainable; for use on barrier with nonlocking flange, with filter (two-piece system), each

Rates data updated October 2026.

How much does Ostomy Pouch, Drainable, Nonlocking Flange, with Filter cost?

$2.75

Typical negotiated rate. In Utah, October 2026.

Insurers have agreed to pay about $2.75 for this service. The price depends on where it is billed: about $2.88 from a physician practice, and about $1.38 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$2.88$2.04 to $3.55
FacilityA hospital or hospital-owned outpatient department$1.38$1.38 to $3.02

How much rates vary

Facilitymedian $1 · 10th to 90th $1 to $3Professionalmedian $3 · 10th to 90th $1 to $5
$2$5$10$20$50facility $1professional $3

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
$1.38
Median
$1.38
Typical High
$1.38
Aetna
Setting
Professional
Modifier
None
Typical Low
$1.38
Median
$1.38
Typical High
$1.38
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$0.69
Median
$0.69
Typical High
$0.79
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$0.27
Median
$0.27
Typical High
$0.31
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.21
Median
$0.21
Typical High
$0.24
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.14
Median
$0.14
Typical High
$0.16
Cigna
Setting
Facility
Modifier
None
Typical Low
$3.02
Median
$3.02
Typical High
$3.24
Cigna
Setting
Professional
Modifier
None
Typical Low
$2.57
Median
$2.57
Typical High
$3.02
Molina
Setting
Professional
Modifier
None
Typical Low
$3.63
Median
$3.63
Typical High
$60.26
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$3.55
Median
$3.55
Typical High
$3.55
Select Health
Setting
Facility
Modifier
None
Typical Low
$5.13
Median
$5.13
Typical High
$5.13
Select Health
Setting
Professional
Modifier
None
Typical Low
$2.51
Median
$5.13
Typical High
$5.13
U of Utah Health Plan
Setting
Professional
Modifier
None
Typical Low
$3.31
Median
$4.17
Typical High
$6.17
United
Setting
Professional
Modifier
None
Typical Low
$1.66
Median
$2.14
Typical High
$4.17

Where Utah sits

The same service costs 2.3 times more in Kansas than in Connecticut. 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

$2.75

KS $6.03CT $2.57

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.