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Maine 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
$161.62 / $269.12 / $430.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.61 / $392.01 / $726.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.00 / $275.94 / $303.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.78 / $243.78 / $398.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.21 / $243.78 / $297.33
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.85 / $271.85 / $271.85
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.62 / $269.12 / $430.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.20 / $311.92 / $688.78