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Ostomy Pouch, Drainable, Nonlocking Flange, with Filter

Pennsylvania 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$270%10%20%10th90th$4Professionalmedian $3 · 10th–90th $2$50%50%10th90th$3$0.1$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$2.45
Median
$3.89
Typical High
$4.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.19
Median
$3.09
Typical High
$4.68
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$5.13
Typical High
$5.13
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$2.57
Median
$3.24
Typical High
$3.24
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$5.01
Typical High
$5.01
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.02
Median
$3.02
Typical High
$6.92
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.57
Median
$2.57
Typical High
$3.09
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$2.63
Median
$5.62
Typical High
$9.77
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$5.13
Median
$5.13
Typical High
$5.13
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$3.09
Median
$3.55
Typical High
$5.13
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.47
Median
$3.72
Typical High
$5.13
Independence Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$3.24
Median
$3.24
Typical High
$3.24
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$2.45
Median
$3.98
Typical High
$4.47
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$1.74
Median
$3.09
Typical High
$4.68
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$8.32
Median
$17.78
Typical High
$28.84
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$3.55
Median
$4.79
Typical High
$4.79
United
Setting
Facility
Modifier
Global
Typical Low
$1.70
Median
$2.29
Typical High
$3.24
United
Setting
Professional
Modifier
Global
Typical Low
$1.78
Median
$2.51
Typical High
$5.62