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Hawaii rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.19 / $1.19 / $1.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.38 / $2.38 / $2.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $1.66 / $3.31
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.01 / $3.15 / $3.15
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.11 / $3.01 / $4.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $2.38 / $3.31
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.50 / $2.87