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Massachusetts rates for HCPCS E1390

Oxygen Concentrator Single Delivery Port Capable Of Delivering 85 Percent Or Greater Oxygen Concentration At The Prescribed Flow Rate. (Rvsd 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$995.06 / $995.06 / $995.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.66 / $953.21 / $1,005.44
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.76 / $4,782.72 / $5,008.26
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.46 / $160.33 / $4,687.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$171.29 / $201.09 / $269.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$228.00 / $228.00 / $228.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.60 / $750.60 / $4,077.00
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.48 / $119.48 / $119.48
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.28 / $116.28 / $116.28
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $4,782.72 / $5,008.26
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.46 / $160.33 / $4,687.97
Tufts
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.50 / $127.50 / $127.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.85 / $114.26 / $813.78