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North Carolina 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
$11.75 / $11.75 / $16.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.50 / $11.75 / $11.75
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.89 / $8.05 / $8.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.76 / $17.84 / $19.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.34 / $10.06 / $10.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $9.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $8.07 / $15.38
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.36 / $11.75 / $14.10
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.40 / $10.40 / $10.40
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.10 / $16.10 / $24.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.46 / $6.37 / $10.32
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $80.00 / $80.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.78 / $100.58 / $100.58