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Indiana 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
$11.49 / $11.49 / $13.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.40 / $8.35 / $11.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.56 / $6.56 / $12.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.19 / $6.56 / $11.96
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.40 / $14.75 / $20.12
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.41 / $16.09 / $18.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $8.07 / $13.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $6.40 / $9.08