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Custom Fabricated Wheelchair Back Cushion

Wisconsin rates for HCPCS E2617

Custom fabricated wheelchair back cushion, any size, including any type mounting hardware

Rates data updated July 2026.

Facilitymedian $372 · 10th–90th $65$6030%20%10th90th$372Professionalmedian $339 · 10th–90th $339$9770%50%90th$339$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$338.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$338.84
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$1,905.46
Typical High
$1,905.46
Cigna
Setting
Facility
Modifier
Global
Typical Low
$407.38
Median
$407.38
Typical High
$2,754.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$851.14
Typical High
$954.99
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$602.56
Medica
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$371.54
Typical High
$501.19
Medica
Setting
Professional
Modifier
Global
Typical Low
$1,445.44
Median
$1,445.44
Typical High
$1,445.44
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$54.95
Typical High
$89.13
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$602.56
Quartz
Setting
Professional
Modifier
Global
Typical Low
$2,691.53
Median
$3,548.13
Typical High
$3,630.78
Quartz
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$371.54
Typical High
$407.38
Quartz
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$407.38
Typical High
$416.87
Security Health
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$933.25
Typical High
$933.25