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Utah rates for HCPCS 64890

Nerve graft (includes obtaining graft), single strand, hand or foot; up to 4 cm length

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $3,715.35 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,548.82 / $5,370.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,479.11 / $2,511.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,344.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,332.54 / $11,220.18 / $26,302.68
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,089.30 / $3,715.35
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,995.26 / $2,630.27
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,698.24 / $2,630.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,148.15 / $1,819.70