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South Dakota rates for HCPCS E1390

Oxygen Concentrator Single Delivery Port Capable Of Delivering 85 Percent Or Greater Oxygen Concentration At The Prescribed Flow Rate. (Rvsd 1/1/04)

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
$92.37 / $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 / $1,811.71 / $4,782.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.58 / $83.64 / $3,117.96
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 / $2,291.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.58 / $83.64 / $1,165.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,863.19 / $1,863.19 / $1,863.19