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Ostomy Pouch, Closed, Locking Flange, with Filter

Utah 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 $1 · 10th–90th $1$20%50%90th$1Professionalmedian $2 · 10th–90th $1$110%10%20%10th90th$2$0.0$0.1$0.5$2.0$10.0$50.0

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
$0.71
Median
$0.71
Typical High
$0.71
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.71
Median
$1.70
Typical High
$11.22
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.55
Median
$1.55
Typical High
$1.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$1.32
Typical High
$1.82
Molina
Setting
Professional
Modifier
Global
Typical Low
$1.55
Median
$1.91
Typical High
$2.57
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$1.45
Median
$1.86
Typical High
$2.88
Select Health
Setting
Facility
Modifier
Global
Typical Low
$2.63
Median
$2.63
Typical High
$2.63
Select Health
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$2.63
Typical High
$2.63
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$2.00
Median
$2.63
Typical High
$3.16
United
Setting
Facility
Modifier
Global
Typical Low
$0.87
Median
$1.00
Typical High
$1.10
United
Setting
Professional
Modifier
Global
Typical Low
$0.85
Median
$1.10
Typical High
$1.66