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Montana rates for HCPCS E0439

Stationary Liquid Oxygen System Rental; Includes Container Contents Regulator Flowmeter Humidifier Nebulizer Cannula Or Mask & Tubing (Special Coverage Instructions Apply. See Cim: 60-4 And Mcm: 4107.9)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$412.09 / $851.10 / $914.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.96 / $168.96 / $168.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.76 / $71.76 / $5,177.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.68 / $170.35 / $869.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.76 / $112.33 / $188.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.85 / $60.85 / $103.90