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Hawaii rates for HCPCS A4428

Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.45 / $4.45 / $4.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.23 / $7.23 / $7.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.43 / $6.43 / $10.02
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.11 / $9.53 / $9.53
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $9.11 / $12.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.53 / $7.23 / $10.02
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.33 / $7.59 / $8.67