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Idaho rates for HCPCS L6677

Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.58 / $293.82 / $293.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.22 / $231.66 / $231.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.11 / $169.11 / $246.96
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.04 / $246.21 / $349.53
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.58 / $332.05 / $349.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $257.95 / $307.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.06 / $341.34 / $512.01
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.67 / $253.44 / $367.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.56 / $159.61 / $253.13