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Oregon 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
Professional
Modifier
Low / Median / High Price
$4.82 / $9.84 / $38.72
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 / $6.86 / $9.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.39 / $24.14 / $29.52
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.84 / $13.41 / $14.75
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.88 / $12.74 / $14.08
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.04 / $13.10 / $15.42
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.04 / $13.41 / $14.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.36 / $11.76 / $13.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $11.75 / $14.75
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.53 / $14.75 / $14.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.42 / $5.69 / $10.85