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Ostomy Pouch, Drainable, Nonlocking Flange, with Filter

Michigan 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 $6 · 10th–90th $2$230%20%10th90th$6Professionalmedian $4 · 10th–90th $2$50%10%20%10th90th$4$0.1$0.2$1.0$5.0$20.0

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
$3.80
Median
$3.80
Typical High
$3.80
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.38
Median
$3.16
Typical High
$3.80
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$3.09
Median
$5.01
Typical High
$5.13
BCBS
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$15.14
Typical High
$28.84
BCBS
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$5.01
Typical High
$5.25
CareSource
Setting
Facility
Modifier
Global
Typical Low
$3.24
Median
$6.03
Typical High
$9.55
CareSource
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$7.08
Typical High
$7.08
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.02
Median
$3.02
Typical High
$3.16
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$3.55
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$2.82
Median
$3.16
Typical High
$10.47
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$2.04
Median
$3.98
Typical High
$6.17
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$4.07
United
Setting
Facility
Modifier
Global
Typical Low
$1.38
Median
$1.95
Typical High
$3.24
United
Setting
Professional
Modifier
Global
Typical Low
$1.66
Median
$2.34
Typical High
$3.55