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Pennsylvania 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
$680.88 / $714.92 / $714.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.66 / $753.66 / $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 / $1,017.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.60 / $750.60 / $750.60
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.85 / $155.85 / $155.85
Independence Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.57 / $694.57 / $694.57
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
$92.37 / $680.88 / $896.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $1,017.80
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.60 / $750.60 / $4,077.00
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
$60.85 / $88.90 / $591.15