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Hawaii rates for HCPCS A5054

Ostomy pouch, closed; for use on barrier with flange (two piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.22 / $1.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.78 / $1.78 / $2.76
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.63 / $2.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.76 / $2.50 / $3.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $2.00 / $2.76
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $2.09 / $2.39