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West Virginia 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
$7.40 / $7.40 / $7.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.40 / $8.23 / $9.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.41 / $16.09 / $20.12
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.39 / $16.09 / $31.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.53 / $15.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $8.07 / $64.88
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.00 / $8.00 / $9.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.26 / $6.70 / $10.50