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New Hampshire 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
$166.46 / $207.88 / $213.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.20 / $340.20 / $340.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.08 / $295.08 / $318.69
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 / $319.95
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.85 / $763.11 / $967.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.47 / $188.20 / $338.03
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.91 / $374.40 / $476.50