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Ohio 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
$3,694.91 / $3,694.91 / $3,694.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.05 / $695.78 / $3,694.91
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.99 / $811.99 / $3,946.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.00 / $600.00 / $990.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48,999.51 / $61,249.39 / $61,249.39
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 / $347.75 / $750.00
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.00 / $405.00 / $413.10
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.00 / $405.00 / $413.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.00 / $50.00 / $50.00