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Hawaii rates for HCPCS A4412

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), without filter, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.85 / $1.85 / $1.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.00 / $3.00 / $3.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.67 / $2.67 / $4.16
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.78 / $3.96 / $3.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $3.78 / $5.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.70 / $4.16
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.70 / $3.15 / $3.60