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Hawaii rates for HCPCS A4413

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), with filter, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.76 / $3.76 / $3.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.11 / $6.11 / $6.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.44 / $5.44 / $8.47
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.70 / $8.06 / $8.06
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.39 / $7.70 / $10.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $6.11 / $8.47
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.20 / $6.41 / $7.33