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Michigan 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
$204.17 / $204.17 / $204.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $181.97 / $295.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $1,071.52 / $2,041.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $354.81 / $380.19
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $234.42 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $229.09 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $229.09 / $416.87
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $676.08 / $758.58
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $288.40 / $436.52
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $229.09 / $229.09
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $229.09 / $245.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $288.40 / $436.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $169.82 / $251.19