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Utah 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
$143.10 / $143.10 / $143.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.10 / $250.56 / $349.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.88 / $66.81 / $558.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.34 / $35.96 / $48.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.45 / $23.17 / $31.79