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Minnesota 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 / $241.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.46 / $241.75 / $291.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.67 / $445.84 / $478.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.17 / $472.71 / $508.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.78 / $326.36 / $928.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.88 / $435.18 / $547.21
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.57 / $656.57 / $730.85
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.88 / $430.88 / $430.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.62 / $508.84 / $1,749.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.77 / $209.38 / $535.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.77 / $209.38 / $425.77