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Pennsylvania 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 / $729.83
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.38 / $775.58 / $775.58
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 / $750.00
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.33 / $1,018.80 / $2,605.12
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.05 / $336.05 / $3,008.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.00 / $405.00 / $405.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.25 / $405.00 / $937.50
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$815.15 / $815.15 / $815.15