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Ostomy Pouch, Closed, Locking Flange, with Filter

Wisconsin 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 $2$50%20%40%10th90th$3Professionalmedian $2 · 10th–90th $1$40%10%20%10th90th$2$1.0$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
$1.51
Median
$1.51
Typical High
$1.51
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.51
Median
$1.51
Typical High
$2.24
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2.63
Median
$2.63
Typical High
$4.37
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.34
Median
$2.45
Typical High
$2.95
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.55
Median
$8.13
Typical High
$13.49
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$3.80
Typical High
$5.01
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$1.45
Median
$2.24
Typical High
$3.80
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$2.34
Median
$3.89
Typical High
$4.79
Medica
Setting
Facility
Modifier
Global
Typical Low
$1.48
Median
$2.57
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$1.10
Median
$1.29
Typical High
$2.82
Molina
Setting
Professional
Modifier
Global
Typical Low
$1.66
Median
$33.11
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$4.17
Median
$4.17
Typical High
$4.17
Network Health
Setting
Professional
Modifier
Global
Typical Low
$1.86
Median
$2.95
Typical High
$5.13
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$1.45
Median
$2.24
Typical High
$3.80
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$1.48
Median
$1.48
Typical High
$2.57
Quartz
Setting
Professional
Modifier
Global
Typical Low
$2.63
Median
$3.98
Typical High
$7.08
Quartz
Setting
Facility
Modifier
Global
Typical Low
$1.55
Median
$5.37
Typical High
$79.43
Quartz
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$3.98
Typical High
$13.18
Security Health
Setting
Professional
Modifier
Global
Typical Low
$2.63
Median
$2.63
Typical High
$2.63
Security Health
Setting
Professional
Modifier
Global
Typical Low
$2.63
Median
$2.63
Typical High
$2.63
United
Setting
Facility
Modifier
Global
Typical Low
$0.85
Median
$1.17
Typical High
$2.63
United
Setting
Professional
Modifier
Global
Typical Low
$0.85
Median
$1.29
Typical High
$2.24