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Utah 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
$3,162.28 / $6,025.60 / $11,220.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,698.24 / $6,760.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,737.80 / $3,548.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,398.83
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
$1,949.84 / $2,454.71 / $5,128.61
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $2,344.23 / $3,090.30
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,995.26 / $3,090.30
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
$1,071.52 / $1,318.26 / $2,089.30