go back

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 July 2026.

Facilitymedian $5 · 10th–90th $3$270%20%10th90th$5Professionalmedian $3 · 10th–90th $2$50%20%10th90th$3$0.1$0.2$1.0$5.0$20.0$100.0

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
$2.82
Median
$2.82
Typical High
$5.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.19
Median
$3.09
Typical High
$5.13
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$2.88
Median
$2.88
Typical High
$2.88
BCBS
Setting
Facility
Modifier
Global
Typical Low
$7.76
Median
$13.49
Typical High
$43.65
BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.40
Median
$3.80
Typical High
$3.80
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.02
Median
$3.02
Typical High
$5.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.57
Median
$2.57
Typical High
$5.50
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$5.89
Typical High
$12.02
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$6.46
Typical High
$6.46
Molina
Setting
Professional
Modifier
Global
Typical Low
$2.40
Median
$2.40
Typical High
$4.17
United
Setting
Facility
Modifier
Global
Typical Low
$1.58
Median
$5.13
Typical High
$5.13
United
Setting
Professional
Modifier
Global
Typical Low
$1.78
Median
$2.51
Typical High
$4.37