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Nebraska 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
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 / $413.10 / $937.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.05 / $352.85 / $571.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$673.50 / $673.50 / $673.50
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$948.28 / $973.66 / $973.66