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Oklahoma 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 / $3,008.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,827.47 / $1,827.47 / $1,827.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.00 / $405.00 / $413.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.25 / $405.00 / $750.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.05 / $352.85 / $1,236.00