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Hawaii rates for HCPCS A4375

Ostomy pouch, drainable, with faceplate attached, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.73 / $11.73 / $11.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.58 / $20.58 / $20.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.93 / $16.96 / $28.49
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.90 / $27.12 / $27.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.13 / $25.90 / $36.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.60 / $20.58 / $28.49
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.87 / $21.58 / $24.65