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Oklahoma rates for HCPCS A4389

Ostomy pouch, drainable, with barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.17 / $5.17 / $6.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.09 / $5.09 / $5.17
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.20 / $5.20 / $5.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.60 / $7.60 / $7.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.20 / $7.60 / $7.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.22 / $5.22 / $5.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $5.22 / $6.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.38 / $5.43 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.46 / $4.13 / $8.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.46 / $3.68 / $5.29