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Indiana 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
$247.58 / $247.58 / $247.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.62 / $228.53 / $267.39
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.14 / $340.14 / $453.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.33 / $328.92 / $367.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.08 / $374.60 / $485.44
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.75 / $303.20 / $559.72
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.07 / $289.42 / $515.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.78 / $243.78 / $326.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.21 / $243.78 / $494.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.77 / $198.22 / $362.42