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Hawaii rates for HCPCS A5057

Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.71 / $6.71 / $6.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.54 / $11.54 / $11.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.49 / $9.49 / $15.98
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.53 / $15.21 / $15.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.17 / $14.53 / $20.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.26 / $13.59 / $15.98
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.70 / $12.10 / $13.83