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Michigan 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
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,073.05 / $6,073.05 / $7,952.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.32 / $1,179.90 / $1,656.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.00 / $405.00 / $413.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.00 / $405.00 / $750.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.05 / $715.40 / $821.74