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Ostomy Pouch, Drainable, Nonlocking Flange, with Filter

Missouri 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 $4 · 10th–90th $2$100%20%10th90th$4Professionalmedian $3 · 10th–90th $2$60%20%10th90th$3$0.5$1.0$2.0$5.0$10.0$20.0$50.0

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
$2.14
Median
$5.01
Typical High
$5.01
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.14
Median
$3.02
Typical High
$21.88
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$2.40
Median
$3.55
Typical High
$5.50
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.63
Typical High
$4.68
BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.09
Median
$3.09
Typical High
$5.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.02
Median
$3.02
Typical High
$4.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.57
Median
$2.57
Typical High
$3.02
Medica
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$4.27
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$1.66
Median
$2.51
Typical High
$25.12
United
Setting
Facility
Modifier
Global
Typical Low
$1.91
Median
$3.24
Typical High
$5.13
United
Setting
Professional
Modifier
Global
Typical Low
$1.74
Median
$2.51
Typical High
$3.80