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South Dakota rates for HCPCS E0424

Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$795.00 / $795.00 / $795.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.00 / $1,182.72 / $1,224.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,077.00 / $4,117.77 / $5,096.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.53 / $1,182.72 / $3,240.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.58 / $71.48 / $169.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.53 / $190.65 / $432.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.53 / $196.69 / $355.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.58 / $83.64 / $363.50