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Iowa 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
Facility
Modifier
Low / Median / High Price
$241.75 / $241.75 / $291.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.62 / $221.05 / $333.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.78 / $243.78 / $498.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.78 / $430.88 / $538.59
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.90 / $36.75 / $37.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $629.04 / $1,749.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.15 / $245.13 / $546.89
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.89 / $49.89 / $117.91
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.53 / $59.64 / $117.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.69 / $231.47 / $546.89
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.45 / $408.17 / $408.17