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Pennsylvania rates for HCPCS E0439

Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & 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
$64.00 / $64.00 / $95.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.76 / $4,077.00 / $5,096.25
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
$549.15 / $755.38 / $953.21
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $95.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.76 / $4,077.00 / $5,096.25
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,236.00 / $1,236.00 / $1,236.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,236.00 / $1,236.00 / $1,260.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.74 / $82.06 / $183.04