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Utah 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
$896.80 / $896.80 / $896.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.32 / $869.18 / $933.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.76 / $71.76 / $5,096.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.57 / $71.73 / $93.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.30 / $60.85 / $175.79