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Montana 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
$290.76 / $1,008.49 / $1,008.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.66 / $380.15 / $380.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.66 / $380.15 / $380.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.36 / $362.05 / $380.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.66 / $285.32 / $380.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.25 / $159.61 / $253.13