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Ostomy Pouch, Drainable, Nonlocking Flange, with Filter

Texas 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 $5 · 10th–90th $3$150%10%10th90th$5Professionalmedian $3 · 10th–90th $2$40%20%10th90th$3$0.1$0.5$5.0$50.0$500.0

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
$2.51
Median
$3.31
Typical High
$39.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.14
Median
$3.24
Typical High
$4.37
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$2.40
Median
$3.09
Typical High
$5.13
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3.98
Median
$5.62
Typical High
$13.80
BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.40
Median
$2.40
Typical High
$2.69
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$3.09
Median
$3.80
Typical High
$5.13
Christus
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$120.23
Typical High
$120.23
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
$3.02
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$85.11
Typical High
$85.11
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$37.15
Typical High
$37.15
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$4.17
Typical High
$7.08
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$3.09
Median
$4.37
Typical High
$5.13
Molina
Setting
Professional
Modifier
Global
Typical Low
$2.82
Median
$2.82
Typical High
$81.28
Providence
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$3.98
Typical High
$7.08
Providence
Setting
Professional
Modifier
Global
Typical Low
$2.57
Median
$2.57
Typical High
$3.16
United
Setting
Facility
Modifier
Global
Typical Low
$1.66
Median
$2.29
Typical High
$5.13
United
Setting
Professional
Modifier
Global
Typical Low
$1.78
Median
$2.29
Typical High
$3.02
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$5.13
Typical High
$6.92