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Montana rates for HCPCS 64895

Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; up to 4 cm length

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,778.28 / $3,467.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,862.09 / $2,238.72
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,290.87 / $2,754.23
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,290.87 / $2,754.23
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,905.46 / $2,630.27
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,819.70 / $2,691.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,187.76 / $2,511.89