go back

South Dakota 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
$795.00 / $795.00 / $795.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.00 / $1,182.72 / $1,224.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,077.00 / $4,117.77 / $5,096.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.53 / $424.06 / $3,008.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.58 / $71.48 / $159.41
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.53 / $190.65 / $432.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.53 / $196.69 / $355.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.76 / $62.73 / $128.74