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Montana rates for HCPCS 64897

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,254.11 / $1,696.50 / $6,606.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,998.57 / $1,998.57 / $1,998.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,104.43 / $1,998.57 / $2,126.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$989.10 / $1,360.01 / $1,998.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,212.15 / $1,998.57 / $2,622.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,723.96 / $2,090.76 / $2,420.88