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Ostomy Pouch, Drainable, Nonlocking Flange, with Filter

Montana 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?

$5.25

Typical negotiated rate. In Montana, October 2026.

Insurers have agreed to pay about $5.25 for this service. The price depends on where it is billed: about $5.25 from a physician practice, and about $5.13 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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$5.25$3.98 to $5.25
FacilityA hospital or hospital-owned outpatient department$5.13$4.90 to $6.31

How much rates vary

Facilitymedian $5 · 10th to 90th $5 to $295Professionalmedian $5 · 10th to 90th $2 to $79
$2$5$10$20$50$100$200facility $5professional $5

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
Professional
Modifier
None
Typical Low
$1.38
Median
$4.27
Typical High
$6.76
BCBS Montana
Setting
Facility
Modifier
None
Typical Low
$4.90
Median
$4.90
Typical High
$4.90
BCBS Montana
Setting
Professional
Modifier
None
Typical Low
$4.90
Median
$4.90
Typical High
$4.90
Cigna
Setting
Facility
Modifier
None
Typical Low
$4.68
Median
$5.25
Typical High
$5.25
Cigna
Setting
Professional
Modifier
None
Typical Low
$4.27
Median
$5.25
Typical High
$5.25
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$3.89
Median
$6.31
Typical High
$302.00
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$5.13
Median
$5.62
Typical High
$309.03
Providence
Setting
Facility
Modifier
None
Typical Low
$3.02
Median
$5.25
Typical High
$5.25
Providence
Setting
Professional
Modifier
None
Typical Low
$3.98
Median
$5.25
Typical High
$79.43
United
Setting
Professional
Modifier
None
Typical Low
$2.04
Median
$2.14
Typical High
$3.55

Where Montana 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.

Montana· 4th of 51

$5.25

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.