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South Carolina 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
Facility
Modifier
Low / Median / High Price
$732.13 / $732.13 / $732.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.95 / $732.13 / $927.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $95.00 / $95.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.76 / $83.43 / $5,177.79
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.00 / $732.13 / $988.38
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,732.00 / $2,732.00 / $2,732.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.26 / $77.62 / $148.80