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Utah 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
$891.25 / $891.25 / $891.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $870.96 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $758.58 / $758.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $60.26 / $151.36
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $81.28 / $81.28
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $100.00 / $144.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $70.79 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $199.53 / $549.54