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Utah 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 / $1,126.92
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 / $430.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.17 / $241.21 / $348.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.62 / $187.15 / $359.16