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Hawaii rates for HCPCS A5052

Ostomy pouch, closed; without barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $1.26 / $1.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.86 / $2.63
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.14 / $2.24
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $2.14 / $2.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $0.79 / $0.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.93 / $1.48 / $2.29