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Wisconsin rates for HCPCS E1392

Portable oxygen concentrator, rental

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.32 / $313.32 / $313.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.13 / $268.56 / $358.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.60 / $450.60 / $820.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.80 / $419.06 / $513.67
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $58.58 / $96.43
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.68 / $55.22 / $74.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.59 / $1,505.83 / $2,309.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.57 / $558.75 / $698.44
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.32 / $210.13 / $455.90
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.30 / $41.30 / $58.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.30 / $312.08 / $5,280.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.17 / $30.98 / $309.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $50.00 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.32 / $211.19 / $455.90
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.30 / $41.30 / $58.02
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.31 / $104.12 / $142.80
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $5,280.00 / $5,280.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.33 / $61.57 / $102.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.50 / $30.90 / $63.35