go back

Pennsylvania rates for HCPCS E1391

Oxygen concentrator, dual delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate, each

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
$1,017.80 / $1,017.80 / $1,017.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.60 / $750.60 / $750.60
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 / $927.12
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,017.80 / $1,017.80 / $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 / $103.90 / $866.55