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Ostomy Pouch, Drainable, Extended Wear, Convexity, Filter

Pennsylvania rates for HCPCS A5057

Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (one piece), each

Rates data updated July 2026.

Facilitymedian $8 · 10th–90th $7$650%20%40%10th90th$8Professionalmedian $8 · 10th–90th $6$130%20%10th90th$8$0.1$1.0$10.0$100.0$1.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$10.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$8.32
Typical High
$12.59
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$13.80
Typical High
$13.80
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$8.71
Typical High
$8.71
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$13.49
Median
$13.49
Typical High
$13.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$18.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$8.32
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$17.78
Typical High
$25.70
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$13.80
Typical High
$13.80
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$9.55
Typical High
$13.80
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$10.00
Typical High
$10.00
Independence Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$8.71
Typical High
$8.71
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$10.47
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$8.32
Typical High
$11.22
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$50.12
Typical High
$77.62
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$12.88
Typical High
$12.88
United
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$6.17
Typical High
$8.71
United
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$6.76
Typical High
$13.80