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Indiana 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
$290.94 / $290.94 / $290.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.10 / $268.56 / $349.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$280.10 / $280.10 / $540.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.08 / $280.10 / $378.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.36 / $58.02 / $72.53
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.06 / $54.07 / $63.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.88 / $66.81 / $66.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.45 / $23.17 / $32.07