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Ostomy Pouch, Closed, Locking Flange, with Filter

Illinois rates for HCPCS A4423

Ostomy pouch, closed; for use on barrier with locking flange, with filter (two piece), each

Rates data updated July 2026.

Facilitymedian $3 · 10th–90th $1$150%20%10th90th$3Professionalmedian $2 · 10th–90th $1$30%20%10th90th$2$0.0$0.1$0.5$2.0$10.0$50.0$200.0

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
$1.45
Median
$1.45
Typical High
$2.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.20
Median
$1.62
Typical High
$2.63
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$1.74
Median
$1.74
Typical High
$1.74
BCBS
Setting
Facility
Modifier
Global
Typical Low
$4.68
Median
$8.13
Typical High
$22.39
BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.00
Median
$2.00
Typical High
$2.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.55
Median
$1.55
Typical High
$2.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$1.32
Typical High
$2.82
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$2.57
Median
$3.09
Typical High
$4.68
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$3.39
Median
$3.39
Typical High
$3.39
Molina
Setting
Professional
Modifier
Global
Typical Low
$1.23
Median
$1.23
Typical High
$1.23
United
Setting
Facility
Modifier
Global
Typical Low
$0.83
Median
$2.63
Typical High
$2.63
United
Setting
Professional
Modifier
Global
Typical Low
$0.91
Median
$1.29
Typical High
$2.29