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

Utah 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?

$3.72

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $3.72 for this service. The price depends on where it is billed: about $3.72 from a physician practice, and about $1.41 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 7 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$3.72$2.63 to $5.62
FacilityA hospital or hospital-owned outpatient department$1.41$1.41 to $1.74

How much rates vary

Facilitymedian $1 · 10th to 90th $1 to $3Professionalmedian $4 · 10th to 90th $1 to $23
$0.1$1.0$10.0facility $1professional $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
Facility
Modifier
Global
Typical Low
$1.41
Median
$1.41
Typical High
$1.41
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.41
Median
$3.39
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
$3.72
Molina
Setting
Professional
Modifier
Global
Typical Low
$3.09
Median
$3.80
Typical High
$5.13
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$2.88
Median
$3.72
Typical High
$5.89
Select Health
Setting
Facility
Modifier
Global
Typical Low
$5.37
Median
$5.37
Typical High
$5.37
Select Health
Setting
Professional
Modifier
Global
Typical Low
$2.63
Median
$5.37
Typical High
$5.37
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$5.37
Typical High
$6.31
United
Setting
Facility
Modifier
Global
Typical Low
$1.74
Median
$2.04
Typical High
$2.57
United
Setting
Professional
Modifier
Global
Typical Low
$1.74
Median
$2.19
Typical High
$3.31

Where Utah 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.

Utah $3.72 · 22nd 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.