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Montana 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 / $161.62 / $161.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.78 / $47.78 / $47.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.78 / $243.78 / $476.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.78 / $443.67 / $476.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.78 / $407.07 / $709.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.78 / $443.67 / $476.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.15 / $187.15 / $311.92