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South Dakota 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.10 / $296.10 / $296.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.10 / $358.26 / $455.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.75 / $564.34 / $698.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.35 / $80.00 / $981.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.29 / $24.24 / $40.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.79 / $58.12 / $131.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.79 / $62.96 / $116.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.50 / $24.24 / $38.58