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Oklahoma rates for HCPCS A4428

Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.43 / $5.43 / $6.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.35 / $5.35 / $5.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.98 / $7.98 / $7.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.42 / $7.98 / $7.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $6.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $5.47 / $6.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $5.70 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.57 / $4.34 / $9.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.57 / $3.86 / $5.53