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Montana rates for HCPCS 64891

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,548.82 / $3,019.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $1,819.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,584.89 / $1,949.84
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $1,995.26 / $2,398.83
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,995.26 / $2,398.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,621.81 / $2,290.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,584.89 / $2,344.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,905.46 / $2,187.76