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Texas 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
$170.97 / $228.99 / $334.60
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.39 / $303.39 / $303.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.26 / $28.07 / $28.07
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.55 / $355.55 / $508.84
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 / $326.36
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$560.79 / $1,749.66 / $1,749.66
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.62 / $347.84 / $508.84
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.81 / $351.07 / $508.84
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.62 / $283.95 / $508.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.21 / $243.78 / $319.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.96 / $236.15 / $359.16
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.38 / $295.08 / $295.08