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Washington rates for HCPCS E0439

Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.32 / $640.32 / $640.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.66 / $726.41 / $1,005.44
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $199.28 / $199.28
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.86 / $700.20 / $1,819.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.76 / $83.43 / $5,177.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $75.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.33 / $112.33 / $112.33
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.98 / $102.81 / $1,028.09
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.78 / $153.78 / $187.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.85 / $79.23 / $122.34
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$700.20 / $700.20 / $700.20