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Wisconsin rates for HCPCS E2617

Custom Fabricated Wheelchair Back Cushion Any Size Including Any Type

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 / $821.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.50 / $1,615.00 / $1,900.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.00 / $405.00 / $2,048.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.00 / $750.00 / $937.50
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.05 / $336.05 / $604.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.05 / $374.50 / $504.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,446.12 / $1,446.12 / $1,446.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $55.00 / $65.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.05 / $336.05 / $604.89
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $374.50 / $405.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.00 / $405.00 / $413.10
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$787.64 / $926.64 / $926.64