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Alaska rates for HCPCS A5057

Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $8.91 / $18.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $8.13 / $8.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $6.92 / $8.32
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.32 / $12.88 / $13.18
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $13.18 / $44.67
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $13.18 / $13.18
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.72 / $13.18 / $16.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.32 / $8.32 / $14.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $10.00 / $60.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.47 / $4.47 / $5.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $27.54