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Ostomy Pouch, Closed, Locking Flange, with Filter

Texas 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$50%20%10th90th$2Professionalmedian $2 · 10th–90th $1$20%20%10th90th$2$0.0$0.2$2.0$20.0$200.0$2.0K

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
$1.29
Median
$1.70
Typical High
$1.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.70
Typical High
$2.29
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$1.74
Median
$1.74
Typical High
$1.74
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1.38
Median
$1.38
Typical High
$1.66
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.23
Median
$1.23
Typical High
$1.38
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$1.58
Median
$2.09
Typical High
$3.24
Christus
Setting
Facility
Modifier
Global
Typical Low
$2.63
Median
$2.63
Typical High
$79.43
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.55
Median
$1.55
Typical High
$1.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$1.32
Typical High
$1.55
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
$13.18
Median
$19.50
Typical High
$19.50
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$1.29
Median
$2.19
Typical High
$3.72
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$1.58
Median
$2.24
Typical High
$2.63
Molina
Setting
Professional
Modifier
Global
Typical Low
$1.45
Median
$1.45
Typical High
$81.28
Providence
Setting
Facility
Modifier
Global
Typical Low
$1.29
Median
$2.09
Typical High
$3.72
Providence
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$1.32
Typical High
$1.66
United
Setting
Facility
Modifier
Global
Typical Low
$0.87
Median
$1.20
Typical High
$2.63
United
Setting
Professional
Modifier
Global
Typical Low
$0.91
Median
$1.20
Typical High
$1.58
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$2.63
Typical High
$3.55