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

New Mexico rates for HCPCS A4417

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

Rates data updated July 2026.

Facilitymedian $4 · 10th–90th $1$50%10%10th90th$4Professionalmedian $3 · 10th–90th $2$90%20%10th90th$3$2.0$5.0$10.0$20.0$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
$3.80
Median
$3.80
Typical High
$3.80
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.51
Median
$3.72
Typical High
$22.91
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.16
Median
$3.16
Typical High
$3.16
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.63
Median
$2.63
Typical High
$7.59
Molina
Setting
Professional
Modifier
Global
Typical Low
$4.17
Median
$5.25
Typical High
$9.12
Providence
Setting
Facility
Modifier
Global
Typical Low
$1.41
Median
$3.80
Typical High
$5.89
Providence
Setting
Professional
Modifier
Global
Typical Low
$2.63
Median
$2.63
Typical High
$5.50
United
Setting
Facility
Modifier
Global
Typical Low
$2.04
Median
$2.19
Typical High
$5.37
United
Setting
Professional
Modifier
Global
Typical Low
$2.04
Median
$2.19
Typical High
$3.31