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Ohio 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
$8.52 / $8.52 / $16.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.71 / $8.52 / $11.49
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.17 / $3.17 / $10.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.19 / $7.18 / $19.57
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.41 / $13.41 / $13.41
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.40 / $14.75 / $19.91
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.39 / $16.09 / $24.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $15.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $6.86 / $9.49
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.53
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $8.07 / $8.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.15 / $9.83 / $12.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.38 / $6.24 / $8.77