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Ostomy Pouch, Drainable, Nonlocking Flange, with Filter

Ohio 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$50%20%10th90th$4Professionalmedian $3 · 10th–90th $2$50%20%10th90th$3$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
$3.16
Median
$4.17
Typical High
$5.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.38
Median
$3.16
Typical High
$4.27
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$4.07
Median
$4.07
Typical High
$4.07
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$3.09
Typical High
$6.61
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$5.13
Median
$5.13
Typical High
$5.13
CareSource
Setting
Facility
Modifier
Global
Typical Low
$3.72
Median
$6.03
Typical High
$7.08
CareSource
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$6.76
Typical High
$7.94
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.02
Median
$3.02
Typical High
$3.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.57
Median
$2.57
Typical High
$3.16
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$3.02
Median
$3.02
Typical High
$3.16
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$2.57
Median
$2.57
Typical High
$3.09
Molina
Setting
Professional
Modifier
Global
Typical Low
$1.74
Median
$2.45
Typical High
$3.55
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$5.13
Median
$5.62
Typical High
$10.47
United
Setting
Facility
Modifier
Global
Typical Low
$1.58
Median
$2.40
Typical High
$5.13
United
Setting
Professional
Modifier
Global
Typical Low
$1.62
Median
$2.40
Typical High
$3.55