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

Pennsylvania 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?

$3.16

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $3.16 for this service. The price depends on where it is billed: about $3.16 from a physician practice, and about $4.07 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 8 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$3.16$2.63 to $3.89
FacilityA hospital or hospital-owned outpatient department$4.07$2.51 to $16.60

How much rates vary

Facilitymedian $4 · 10th to 90th $3 to $28Professionalmedian $3 · 10th to 90th $2 to $5
$0.1$1.0$10.0$100.0$1.0K$10.0K$100.0Kfacility $4professional $3

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
$2.51
Median
$2.51
Typical High
$4.07
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$3.16
Typical High
$4.90
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$5.25
Median
$5.25
Typical High
$5.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.16
Median
$3.16
Typical High
$7.24
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.63
Median
$2.63
Typical High
$3.24
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$4.90
Median
$6.92
Typical High
$10.00
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$5.37
Median
$5.37
Typical High
$5.37
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$3.16
Median
$3.72
Typical High
$5.37
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$4.07
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$3.16
Typical High
$4.37
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$5.01
Median
$19.05
Typical High
$30.20
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$3.72
Median
$5.01
Typical High
$5.01
United
Setting
Facility
Modifier
Global
Typical Low
$1.74
Median
$2.34
Typical High
$3.31
United
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$2.57
Typical High
$5.62

Where Pennsylvania 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.

Pennsylvania $3.16 · 35th 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.