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Arizona rates for HCPCS E2617

Custom fabricated wheelchair back cushion, any size, including any type mounting hardware

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.05 / $3,694.91 / $3,694.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.80 / $22.80 / $28.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.68 / $592.84 / $985.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.00 / $405.00 / $405.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.25 / $405.00 / $937.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.05 / $336.05 / $3,694.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$673.50 / $673.50 / $673.50