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Hawaii rates for HCPCS A4387

Ostomy pouch, closed, with barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.50 / $2.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $3.45
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.14 / $3.29 / $3.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.20 / $3.14 / $4.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $3.11 / $3.45
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.52 / $2.62 / $2.99