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

Illinois 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?

$3.31

Typical negotiated rate. In Illinois, October 2026.

Insurers have agreed to pay about $3.31 for this service. The price depends on where it is billed: about $3.16 from a physician practice, and about $11.22 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$3.16$2.57 to $3.98
FacilityA hospital or hospital-owned outpatient department$11.22$5.37 to $25.70

How much rates vary

Facilitymedian $11 · 10th to 90th $3 to $44Professionalmedian $3 · 10th to 90th $2 to $6
$2$5$10$20$50facility $11professional $3

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$2.45
Median
$2.95
Typical High
$5.37
Aetna
Setting
Professional
Modifier
None
Typical Low
$2.45
Median
$2.95
Typical High
$4.47
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$1.23
Median
$1.48
Typical High
$2.24
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$0.49
Median
$0.59
Typical High
$0.89
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.36
Median
$0.44
Typical High
$0.68
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.24
Median
$0.28
Typical High
$0.45
BCBS Illinois
Setting
Facility
Modifier
None
Typical Low
$8.32
Median
$13.80
Typical High
$45.71
BCBS Illinois
Setting
Professional
Modifier
None
Typical Low
$2.45
Median
$3.98
Typical High
$3.98
Cigna
Setting
Facility
Modifier
None
Typical Low
$3.16
Median
$3.16
Typical High
$3.63
Cigna
Setting
Professional
Modifier
None
Typical Low
$2.63
Median
$2.63
Typical High
$3.72
Hally Health
Setting
Professional
Modifier
None
Typical Low
$4.90
Median
$6.17
Typical High
$9.33
Hally Health
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
None
Typical Low
$6.76
Median
$6.76
Typical High
$6.76
Molina
Setting
Professional
Modifier
None
Typical Low
$4.37
Median
$4.37
Typical High
$4.37
United
Setting
Professional
Modifier
None
Typical Low
$2.04
Median
$2.57
Typical High
$6.03

Where Illinois 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.

Illinois· 25th of 51

$3.31

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.