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Utah rates for HCPCS A5057

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

Facilitymedian $4 · 10th–90th $4–$80%50%90th$4Professionalmedian $9 · 10th–90th $4–$590%10%10th90th$9$0.1$0.5$2.0$10.0$50.0

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.98 / $3.98 / $3.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.98 / $8.71 / $58.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.13 / $8.13 / $8.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.92 / $6.92 / $9.55
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.92 / $9.77 / $13.18
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.55 / $9.55 / $15.14
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $13.49 / $13.80
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.23 / $13.80 / $16.60
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4.47 / $5.13 / $5.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.47 / $5.75 / $10.23