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Ostomy Pouch, Drainable, Nonlocking Flange, with Filter

Washington 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$100%20%10th90th$5Professionalmedian $4 · 10th–90th $2$90%10%20%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
$2.82
Median
$2.82
Typical High
$6.76
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.38
Median
$2.82
Typical High
$21.88
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$3.55
Median
$3.55
Typical High
$5.13
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$4.37
Median
$4.37
Typical High
$4.37
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$4.37
Median
$4.37
Typical High
$5.62
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.02
Median
$3.16
Typical High
$3.39
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.57
Median
$2.57
Typical High
$3.02
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$2.88
Median
$5.50
Typical High
$11.22
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$2.88
Median
$6.31
Typical High
$10.96
Molina
Setting
Professional
Modifier
Global
Typical Low
$3.47
Median
$3.80
Typical High
$64.57
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$4.90
Typical High
$5.01
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$4.37
Median
$5.01
Typical High
$5.25
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$4.17
Median
$4.37
Typical High
$8.13
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$4.17
Median
$4.17
Typical High
$4.90
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$4.07
Median
$4.37
Typical High
$5.62
United
Setting
Facility
Modifier
Global
Typical Low
$1.95
Median
$2.04
Typical High
$2.88
United
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$2.29
Typical High
$4.07
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$2.45
Median
$4.37
Typical High
$7.59