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New Hampshire 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
Facility
Modifier
Low / Median / High Price
$2,398.83 / $4,466.84 / $11,481.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,445.44 / $2,884.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,623.41 / $8,912.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $2,511.89 / $3,548.13
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
$1,513.56 / $2,089.30 / $3,715.35
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $11,220.18 / $11,220.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,995.26 / $3,019.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $11,220.18 / $11,220.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,862.09 / $3,548.13
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $933.25 / $1,513.56