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Ostomy Pouch, Drainable, Nonlocking Flange, with Filter

South Carolina 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$70%20%10th90th$4Professionalmedian $4 · 10th–90th $2$40%20%40%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
$3.98
Median
$3.98
Typical High
$3.98
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.19
Median
$3.98
Typical High
$4.37
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$3.02
Median
$3.02
Typical High
$3.16
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3.24
Median
$4.57
Typical High
$5.13
BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$5.13
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
$2.57
Median
$2.57
Typical High
$6.76
Medcost
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$3.24
Medcost
Setting
Facility
Modifier
Global
Typical Low
$2.82
Median
$4.57
Typical High
$8.13
Medcost
Setting
Professional
Modifier
Global
Typical Low
$1.38
Median
$1.38
Typical High
$1.70
Molina
Setting
Professional
Modifier
Global
Typical Low
$3.39
Median
$3.39
Typical High
$3.39
United
Setting
Facility
Modifier
Global
Typical Low
$1.58
Median
$1.95
Typical High
$5.13
United
Setting
Professional
Modifier
Global
Typical Low
$1.66
Median
$2.40
Typical High
$3.24