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Pennsylvania rates for HCPCS E0424

Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$680.88 / $714.92 / $714.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$516.40 / $755.38 / $995.06
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.86 / $93.86 / $93.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.00 / $1,045.06 / $1,045.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.99 / $24.99 / $71.76
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.92 / $714.92 / $714.92
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.95 / $755.38 / $933.81
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.00 / $1,045.06 / $1,045.06
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.99 / $24.99 / $2,460.98
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.11 / $1,236.00 / $1,236.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.11 / $1,236.00 / $1,256.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.85 / $102.44 / $491.16