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Maine 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
Professional
Modifier
Low / Median / High Price
$160.94 / $323.70 / $323.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.00 / $200.00 / $280.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.81 / $66.81 / $66.81
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.94 / $296.10 / $323.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.84 / $24.67 / $41.12