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Indiana rates for HCPCS L6677

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $177.83 / $269.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $363.08 / $457.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $194.98 / $354.81
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $446.68 / $537.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $229.09 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $169.82 / $316.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $251.19 / $288.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $177.83 / $245.47