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Ohio 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
$196.25 / $196.25 / $196.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.25 / $197.98 / $362.97
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.14 / $340.14 / $340.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$333.33 / $459.39 / $735.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.24 / $359.16 / $609.71
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.52 / $490.41 / $508.84
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.75 / $283.73 / $508.84
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.07 / $275.63 / $590.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.78 / $243.78 / $512.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.21 / $243.78 / $430.88
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.78 / $243.78 / $327.93
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.78 / $243.78 / $319.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.68 / $422.11 / $608.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.15 / $221.60 / $338.03