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

Wyoming 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 $2 · 10th–90th $2$50%20%10th90th$2Professionalmedian $4 · 10th–90th $2$50%20%10th90th$4$2.0$5.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.24
Median
$2.24
Typical High
$4.57
BCBS
Setting
Facility
Modifier
Global
Typical Low
$5.13
Median
$5.13
Typical High
$5.13
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
$3.16
Typical High
$3.16
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.63
Median
$2.63
Typical High
$3.16
United
Setting
Facility
Modifier
Global
Typical Low
$2.00
Median
$2.19
Typical High
$2.45
United
Setting
Professional
Modifier
Global
Typical Low
$2.00
Median
$2.19
Typical High
$2.95