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Ostomy Pouch, Closed, One-Piece, Convex, with Filter

Alaska rates for HCPCS A4417

Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (one piece), each

Rates data updated October 2026.

How much does Ostomy Pouch, Closed, One-Piece, Convex, with Filter cost?

$5.01

Typical negotiated rate. In Alaska, October 2026.

Insurers have agreed to pay about $5.01 for this service. The price depends on where it is billed: about $5.01 from a physician practice, and about $5.01 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$5.01$4.47 to $5.13
FacilityA hospital or hospital-owned outpatient department$5.01$3.39 to $5.01

How much rates vary

Facilitymedian $5 · 10th to 90th $3 to $5Professionalmedian $5 · 10th to 90th $3 to $5
$2$5$10$20$50facility $5professional $5

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$5.01
Median
$5.01
Typical High
$5.01
Aetna
Setting
Professional
Modifier
None
Typical Low
$2.29
Median
$5.01
Typical High
$5.01
Cigna
Setting
Facility
Modifier
None
Typical Low
$3.16
Median
$3.16
Typical High
$3.39
Cigna
Setting
Professional
Modifier
None
Typical Low
$2.63
Median
$2.63
Typical High
$5.75
Moda Health
Setting
Facility
Modifier
None
Typical Low
$5.01
Median
$5.01
Typical High
$5.01
Moda Health
Setting
Professional
Modifier
None
Typical Low
$4.47
Median
$5.01
Typical High
$7.24
Premera BCBS
Setting
Facility
Modifier
None
Typical Low
$4.57
Median
$4.57
Typical High
$5.13
Premera BCBS
Setting
Professional
Modifier
None
Typical Low
$4.57
Median
$5.13
Typical High
$5.25
Providence
Setting
Facility
Modifier
None
Typical Low
$1.41
Median
$3.39
Typical High
$7.08
Providence
Setting
Professional
Modifier
None
Typical Low
$2.63
Median
$3.39
Typical High
$60.26
United
Setting
Professional
Modifier
None
Typical Low
$2.51
Median
$2.57
Typical High
$12.02

Where Alaska sits

The same service costs 2.1 times more in Hawaii than in Connecticut. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Alaska· 6th of 51

$5.01

HI $5.62CT $2.63

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.