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Kentucky 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
$336.05 / $336.05 / $336.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.05 / $336.05 / $3,694.91
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.99 / $811.99 / $811.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.20 / $750.00 / $750.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $405.00 / $413.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.25 / $405.00 / $413.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00