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Hawaii rates for HCPCS A4425

Ostomy pouch, drainable; for use on barrier with nonlocking flange, with filter (two-piece system), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.44 / $2.44 / $2.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $3.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.54 / $5.50 / $5.50
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $5.24 / $5.24
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.50 / $5.00 / $7.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.04 / $3.98 / $5.50
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.55 / $4.17 / $4.76