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Utah rates for HCPCS E2617

Custom Fabricated Wheelchair Back Cushion Any Size Including Any Type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.87 / $695.78 / $695.78
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $60.00