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

Tennessee 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?

$3.24

Typical negotiated rate. In Tennessee, July 2026.

Insurers have agreed to pay about $3.24 for this service. The price depends on where it is billed: about $3.24 from a physician practice, and about $4.68 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 6 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$3.24$2.69 to $3.98
FacilityA hospital or hospital-owned outpatient department$4.68$3.02 to $79.43

How much rates vary

Facilitymedian $5 · 10th to 90th $2 to $85Professionalmedian $3 · 10th to 90th $2 to $5
$2.0$5.0$10.0$20.0$50.0facility $5professional $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
$2.69
Median
$3.02
Typical High
$4.68
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.29
Median
$3.31
Typical High
$4.57
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$3.47
Median
$3.47
Typical High
$3.47
BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$3.98
Typical High
$4.27
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.16
Median
$3.16
Typical High
$3.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.63
Median
$2.63
Typical High
$3.16
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$85.11
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$26.30
Median
$38.90
Typical High
$38.90
United
Setting
Facility
Modifier
Global
Typical Low
$2.00
Median
$2.34
Typical High
$5.37
United
Setting
Professional
Modifier
Global
Typical Low
$1.66
Median
$2.40
Typical High
$3.02

Where Tennessee 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.

Tennessee $3.24 · 32nd 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.