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Kansas 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
$14.81 / $14.81 / $14.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.82 / $7.15 / $14.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.59 / $6.94 / $7.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.43 / $7.43 / $7.43
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 / $8.07 / $19.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.15 / $10.82 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $6.70 / $17.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.95 / $6.19 / $8.77