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Missouri 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 / $336.05 / $336.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$608.32 / $637.50 / $750.00
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.05 / $336.05 / $374.50