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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 October 2026.

How much does Ostomy Pouch, Closed, One-Piece, Convex, with Filter cost?

$3.09

Typical negotiated rate. In Tennessee, October 2026.

Insurers have agreed to pay about $3.09 for this service. Most negotiated rates run $2.63 to $3.98.

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.

How much rates vary

Facilitymedian $3 · 10th to 90th $3 to $4Professionalmedian $3 · 10th to 90th $2 to $26
$2$5$10$20facility $3professional $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
$2.69
Median
$2.69
Typical High
$2.69
Aetna
Setting
Professional
Modifier
None
Typical Low
$2.69
Median
$3.24
Typical High
$4.57
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$1.35
Median
$1.62
Typical High
$2.29
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$0.54
Median
$0.65
Typical High
$0.91
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.40
Median
$0.48
Typical High
$0.68
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.27
Median
$0.32
Typical High
$0.46
Ambetter
Setting
Professional
Modifier
None
Typical Low
$3.47
Median
$3.47
Typical High
$3.47
BCBS Tennessee
Setting
Professional
Modifier
None
Typical Low
$3.09
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
$3.16
Lucent Health
Setting
Professional
Modifier
None
Typical Low
$26.30
Median
$39.81
Typical High
$39.81
United
Setting
Professional
Modifier
None
Typical Low
$1.48
Median
$2.40
Typical High
$2.95

Where Tennessee 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.

Tennessee· 36th of 51

$3.09

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.