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Wisconsin rates for HCPCS E0424

Stationary Compressed Gaseous Oxygen System Rental; Includes Container Contents Regulator Flowmeter Humidifier Nebulizer Cannula Or Mask And Tubing (Special Coverage Instructions Apply. See Cim: 60-4 And Mcm: 4107.9)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$879.27 / $879.27 / $879.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$516.40 / $795.00 / $1,004.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$967.00 / $967.00 / $1,759.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.36 / $899.31 / $1,102.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.06 / $206.94 / $206.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,604.23 / $3,043.26 / $4,668.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.99 / $4,077.00 / $5,096.25
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.86 / $456.50 / $1,224.04
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.04 / $159.41 / $159.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.70 / $726.41 / $3,391.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.85 / $104.21 / $216.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $90.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.68 / $470.54 / $1,230.98
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.04 / $159.41 / $159.41
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.97 / $215.34 / $295.33
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $1,217.54 / $3,391.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.99 / $24.99 / $4,271.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.71 / $83.37 / $363.50