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South Dakota rates for HCPCS E0447

Portable oxygen contents, liquid, 1 month's supply = 1 unit, prescribed amount at rest or nighttime exceeds 4 liters per minute (LPM)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.08 / $60.08 / $60.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.08 / $74.98 / $92.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $119.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.63 / $108.70 / $134.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.98 / $93.28 / $205.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.27 / $64.12 / $138.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.27 / $121.84 / $167.45
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.46 / $121.84 / $236.06
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.19 / $97.55 / $122.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.08 / $49.14 / $92.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.60 / $108.60 / $108.60