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

Hawaii 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?

$5.62

Typical negotiated rate. In Hawaii, October 2026.

Insurers have agreed to pay about $5.62 for this service. Most negotiated rates run $5.37 to $5.75.

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.

How much rates vary

Facilitymedian $4 · 10th to 90th $4 to $4Professionalmedian $6 · 10th to 90th $5 to $6
$5facility $4professional $6

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
Professional
Modifier
None
Typical Low
$2.51
Median
$2.51
Typical High
$2.51
Cigna
Setting
Facility
Modifier
None
Typical Low
$3.63
Median
$4.17
Typical High
$4.17
Cigna
Setting
Professional
Modifier
None
Typical Low
$5.75
Median
$5.75
Typical High
$5.75
HMSA
Setting
Professional
Modifier
None
Typical Low
$5.37
Median
$5.37
Typical High
$5.62
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$3.72
Median
$5.37
Typical High
$6.92
United
Setting
Professional
Modifier
None
Typical Low
$3.72
Median
$5.75
Typical High
$5.75
University Health Alliance
Setting
Professional
Modifier
None
Typical Low
$4.17
Median
$4.37
Typical High
$5.01

Where Hawaii 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.

Hawaii· 1st of 51

$5.62

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.