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Ostomy Pouch, Closed, Locking Flange, with Filter

Pennsylvania 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 $2 · 10th–90th $1$140%20%40%10th90th$2Professionalmedian $2 · 10th–90th $1$30%20%40%10th90th$2$0.0$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$1.26
Median
$1.26
Typical High
$2.04
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.58
Typical High
$2.45
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$1.35
Median
$1.70
Typical High
$1.70
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$2.57
Median
$2.57
Typical High
$2.57
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.55
Median
$1.55
Typical High
$3.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$1.32
Typical High
$1.62
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1.38
Median
$2.88
Typical High
$5.01
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$2.63
Median
$2.63
Typical High
$2.63
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$1.58
Median
$1.86
Typical High
$2.63
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$1.95
Typical High
$1.95
Independence Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$1.70
Median
$1.70
Typical High
$1.70
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$1.26
Median
$1.26
Typical High
$2.04
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$1.10
Median
$1.58
Typical High
$2.14
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$1.41
Median
$1.41
Typical High
$1.41
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$2.40
Median
$2.40
Typical High
$2.40
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$2.45
Median
$9.33
Typical High
$15.14
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1.86
Median
$2.45
Typical High
$2.45
United
Setting
Facility
Modifier
Global
Typical Low
$0.87
Median
$1.17
Typical High
$1.66
United
Setting
Professional
Modifier
Global
Typical Low
$0.91
Median
$1.29
Typical High
$2.88