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Virginia 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
$336.05 / $336.05 / $336.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.05 / $336.05 / $336.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $50.00
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 / $413.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,953.00 / $3,241.00 / $3,241.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.05 / $336.05 / $379.74
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.55 / $565.63 / $594.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.55 / $565.63 / $594.00