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Missouri 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
$162.78 / $240.78 / $248.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.78 / $186.52 / $339.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.30 / $374.12 / $1,644.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.90 / $195.45 / $293.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.66 / $231.66 / $231.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.11 / $169.11 / $246.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.78 / $298.43 / $1,667.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.01 / $190.47 / $288.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.01 / $178.65 / $252.31