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Rhode Island 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
$143.10 / $167.31 / $268.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.12 / $39.29 / $45.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.10 / $20.12 / $20.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.81 / $66.81 / $66.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.45 / $25.66 / $44.96