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California rates for HCPCS E2612

General use wheelchair back cushion, width 22 in or greater, any height, including any type mounting hardware

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.87 / $222.33 / $430.99
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.14 / $340.14 / $340.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.28 / $25.80 / $611.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.00 / $359.10 / $481.82
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.42 / $602.42 / $602.42
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $211.09 / $404.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.78 / $243.78 / $404.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.21 / $243.78 / $430.88
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.34 / $369.34 / $443.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.11 / $317.45 / $612.25
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$466.34 / $1,749.66 / $1,749.66
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.62 / $267.39 / $508.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.21 / $243.78 / $297.33
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$737.20 / $737.20 / $737.20
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.66 / $286.66 / $369.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.15 / $202.18 / $333.85