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South Carolina 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
$266.27 / $266.27 / $266.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.94 / $266.27 / $345.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.00 / $38.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.81 / $66.81 / $66.81
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.00 / $256.02 / $345.28
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.00 / $59.00 / $59.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.59 / $20.59 / $20.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.81 / $21.58 / $28.87