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Ostomy Pouch, Drainable, Nonlocking Flange, with Filter

Illinois 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?

$3.16

Typical negotiated rate. In Illinois, October 2026.

Insurers have agreed to pay about $3.16 for this service. The price depends on where it is billed: about $3.02 from a physician practice, and about $10.96 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$3.02$2.51 to $3.80
FacilityA hospital or hospital-owned outpatient department$10.96$5.13 to $24.55

How much rates vary

Facilitymedian $11 · 10th to 90th $3 to $42Professionalmedian $3 · 10th to 90th $2 to $6
$2$5$10$20$50facility $11professional $3

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$2.34
Median
$2.82
Typical High
$5.13
Aetna
Setting
Professional
Modifier
None
Typical Low
$2.34
Median
$2.82
Typical High
$4.27
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$1.17
Median
$1.41
Typical High
$2.14
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$0.47
Median
$0.56
Typical High
$0.85
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.35
Median
$0.42
Typical High
$0.65
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.23
Median
$0.28
Typical High
$0.43
Ambetter
Setting
Professional
Modifier
None
Typical Low
$2.88
Median
$2.88
Typical High
$2.88
BCBS Illinois
Setting
Facility
Modifier
None
Typical Low
$8.32
Median
$13.49
Typical High
$43.65
BCBS Illinois
Setting
Professional
Modifier
None
Typical Low
$2.40
Median
$3.80
Typical High
$3.80
Cigna
Setting
Facility
Modifier
None
Typical Low
$3.02
Median
$3.02
Typical High
$3.16
Cigna
Setting
Professional
Modifier
None
Typical Low
$2.57
Median
$2.57
Typical High
$3.55
Hally Health
Setting
Professional
Modifier
None
Typical Low
$4.27
Median
$5.62
Typical High
$10.72
Hally Health
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
None
Typical Low
$6.46
Median
$6.46
Typical High
$6.46
Molina
Setting
Professional
Modifier
None
Typical Low
$4.17
Median
$4.17
Typical High
$4.17
United
Setting
Professional
Modifier
None
Typical Low
$1.95
Median
$2.51
Typical High
$5.89

Where Illinois 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.

Illinois· 29th of 51

$3.16

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.