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

Michigan 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?

$4.47

Typical negotiated rate. In Michigan, October 2026.

Insurers have agreed to pay about $4.47 for this service. The price depends on where it is billed: about $4.37 from a physician practice, and about $9.55 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 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$4.37$3.72 to $5.25
FacilityA hospital or hospital-owned outpatient department$9.55$3.39 to $16.22

How much rates vary

Facilitymedian $10 · 10th to 90th $3 to $23Professionalmedian $4 · 10th to 90th $2 to $5
$2$5$10$20$50facility $10professional $4

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
$4.68
Median
$4.68
Typical High
$4.90
Aetna
Setting
Professional
Modifier
None
Typical Low
$4.68
Median
$4.90
Typical High
$4.90
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$2.34
Median
$2.45
Typical High
$2.45
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$0.93
Median
$0.98
Typical High
$0.98
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.71
Median
$0.74
Typical High
$0.74
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.47
Median
$0.49
Typical High
$0.49
BCBS Michigan
Setting
Facility
Modifier
None
Typical Low
$6.31
Median
$15.49
Typical High
$28.84
BCBS Michigan
Setting
Professional
Modifier
None
Typical Low
$4.90
Median
$5.25
Typical High
$5.25
CareSource
Setting
Facility
Modifier
None
Typical Low
$3.39
Median
$3.39
Typical High
$3.39
Cigna
Setting
Facility
Modifier
None
Typical Low
$3.16
Median
$3.16
Typical High
$3.39
Cigna
Setting
Professional
Modifier
None
Typical Low
$2.63
Median
$2.63
Typical High
$3.63
Health Alliance Plan
Setting
Facility
Modifier
None
Typical Low
$3.98
Median
$10.23
Typical High
$10.96
Health Alliance Plan
Setting
Professional
Modifier
None
Typical Low
$3.31
Median
$4.17
Typical High
$5.37
Health Alliance Plan
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$2.00
Median
$2.00
Typical High
$2.00
Health Alliance Plan
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$0.79
Median
$0.79
Typical High
$0.79
Health Alliance Plan
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.60
Median
$0.60
Typical High
$0.60
Health Alliance Plan
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.40
Median
$0.40
Typical High
$0.40
Priority Health
Setting
Facility
Modifier
None
Typical Low
$3.16
Median
$3.16
Typical High
$3.39
Priority Health
Setting
Professional
Modifier
None
Typical Low
$2.63
Median
$2.63
Typical High
$3.89
United
Setting
Professional
Modifier
None
Typical Low
$1.82
Median
$2.45
Typical High
$3.47
1 more rate with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
BCBS Michigan
Setting
Professional
Modifier
RR · Rental
Typical Low
$5.25
Median
$5.25
Typical High
$5.25

Where Michigan 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.

Michigan· 13th of 51

$4.47

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.