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Pennsylvania rates for HCPCS A0422

Ambulance (ALS or BLS) oxygen and oxygen supplies, life sustaining situation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.85 / $25.85 / $28.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.10 / $163.10 / $163.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.55 / $22.55 / $22.55
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.85 / $28.26 / $28.27
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,130.56 / $9,130.56 / $9,130.56
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.10 / $163.10 / $163.10
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.55 / $22.55 / $22.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.39 / $31.93 / $78.00