go back

Idaho rates for HCPCS E2617

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,694.91 / $3,694.91 / $3,694.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.05 / $336.05 / $3,694.91
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 / $417.15
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.05 / $364.48 / $1,236.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $55.00 / $55.00