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Iowa 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
Facility
Modifier
Low / Median / High Price
$8.56 / $8.56 / $9.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.03 / $8.52 / $11.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $14.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.53 / $14.75 / $19.22
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.66 / $13.41 / $14.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.57 / $15.46 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.22 / $6.70 / $18.34
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.75 / $14.75 / $17.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.55 / $17.23 / $28.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.22 / $6.70 / $11.49
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.07 / $12.07 / $12.07
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.53 / $12.07 / $12.07