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

Montana rates for HCPCS A4417

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

Rates data updated July 2026.

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

$4.47

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $4.47 for this service. The price depends on where it is billed: about $4.47 from a physician practice, and about $5.13 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$4.47$2.45 to $5.13
FacilityA hospital or hospital-owned outpatient department$5.13$3.98 to $5.50

How much rates vary

Facilitymedian $5 · 10th to 90th $3 to $6Professionalmedian $4 · 10th to 90th $2 to $23
$2.0$5.0$10.0$20.0$50.0facility $5professional $4

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.41
Median
$4.17
Typical High
$22.91
BCBS
Setting
Professional
Modifier
Global
Typical Low
$5.13
Median
$5.13
Typical High
$5.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.16
Median
$5.50
Typical High
$5.50
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.63
Median
$5.50
Typical High
$5.50
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$3.98
Median
$5.13
Typical High
$10.00
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$5.13
Typical High
$10.00
Providence
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$4.79
Typical High
$6.31
Providence
Setting
Professional
Modifier
Global
Typical Low
$3.89
Median
$5.50
Typical High
$79.43
United
Setting
Facility
Modifier
Global
Typical Low
$1.74
Median
$2.00
Typical High
$2.04
United
Setting
Professional
Modifier
Global
Typical Low
$2.00
Median
$2.19
Typical High
$2.95

Where Montana sits

The same service costs 2.1 times more in Hawaii than in Colorado. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Montana $4.47 · 12th of 51
HI $5.37CO $2.57

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.