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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
Facility
Modifier
Low / Median / High Price
$8.91 / $8.91 / $8.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $7.76 / $10.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $8.13 / $8.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $6.92 / $6.92
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.23 / $24.55 / $28.84
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.77 / $10.23 / $14.79
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $10.96 / $14.79
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $13.18 / $13.49
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $13.49 / $13.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $12.59 / $18.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $12.88 / $70.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $15.14 / $15.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.37 / $4.37 / $5.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.75 / $10.96