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Custom Fabricated Wheelchair Back Cushion

Montana rates for HCPCS E2617

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

Rates data updated July 2026.

Facilitymedian $407 · 10th–90th $407$4070%50%100%$407Professionalmedian $3,715 · 10th–90th $79$3,7150%50%10th$3,715$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3,019.95
Median
$3,715.35
Typical High
$3,715.35
Cigna
Setting
Facility
Modifier
Global
Typical Low
$407.38
Median
$407.38
Typical High
$407.38
Cigna
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$407.38
Typical High
$416.87
Providence
Setting
Facility
Modifier
Global
Typical Low
$407.38
Median
$407.38
Typical High
$407.38
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$407.38