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Idaho rates for HCPCS E0434

Portable Liquid Oxygen System Rental; Includes Portable Container Supply Reservoir Humidifier Flowmeter Refill Adaptor Contents Gauge 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
$143.10 / $143.10 / $143.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.10 / $256.02 / $570.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.81 / $66.81 / $66.81
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.31 / $226.15 / $570.23
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.93 / $46.93 / $46.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.40 / $391.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.45 / $18.25 / $34.34