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Arizona 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
$4.03 / $8.05 / $11.75
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.39 / $9.39 / $9.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $11.65 / $21.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.05 / $10.74 / $14.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $6.86 / $9.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.36 / $8.86 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.82 / $5.69 / $8.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.17 / $5.69 / $8.77