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Ostomy Pouch, Drainable, Nonlocking Flange, with Filter

Wisconsin 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 $4$90%20%40%10th90th$5Professionalmedian $5 · 10th–90th $3$90%10%10th90th$5$2.0$5.0$10.0$20.0$50.0$100.0

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
$2.88
Median
$2.88
Typical High
$2.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.88
Median
$2.88
Typical High
$4.37
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$5.13
Median
$5.13
Typical High
$8.51
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$4.79
Typical High
$5.75
CareSource
Setting
Facility
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$6.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.02
Median
$15.49
Typical High
$25.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.57
Median
$7.08
Typical High
$9.55
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$2.82
Median
$4.37
Typical High
$7.24
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$4.57
Median
$7.59
Typical High
$9.33
Medica
Setting
Facility
Modifier
Global
Typical Low
$2.88
Median
$5.01
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$2.14
Median
$2.51
Typical High
$5.50
Molina
Setting
Professional
Modifier
Global
Typical Low
$2.82
Median
$33.11
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$8.13
Network Health
Setting
Professional
Modifier
Global
Typical Low
$3.63
Median
$5.75
Typical High
$10.00
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$2.82
Median
$4.37
Typical High
$7.24
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$2.88
Median
$2.88
Typical High
$5.01
Quartz
Setting
Professional
Modifier
Global
Typical Low
$5.13
Median
$7.59
Typical High
$13.18
Quartz
Setting
Facility
Modifier
Global
Typical Low
$3.02
Median
$10.23
Typical High
$79.43
Quartz
Setting
Professional
Modifier
Global
Typical Low
$2.57
Median
$7.59
Typical High
$25.12
Security Health
Setting
Professional
Modifier
Global
Typical Low
$5.13
Median
$5.13
Typical High
$5.13
Security Health
Setting
Professional
Modifier
Global
Typical Low
$5.13
Median
$5.13
Typical High
$5.13
United
Setting
Facility
Modifier
Global
Typical Low
$1.62
Median
$2.29
Typical High
$5.13
United
Setting
Professional
Modifier
Global
Typical Low
$1.66
Median
$2.51
Typical High
$4.27