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Washington 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
$1,733.00 / $5,128.00 / $20,680.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,167.45 / $1,586.37 / $3,654.15
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,433.20 / $18,458.89 / $36,111.08
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,875.67 / $2,909.45 / $11,065.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.97 / $870.49 / $7,318.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,363.73 / $2,263.31 / $3,818.12
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,358.98 / $2,751.01 / $6,417.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,227.72 / $2,644.80 / $5,526.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.32 / $579.56 / $2,613.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.30 / $2,457.56 / $2,546.67
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,697.39 / $1,737.06 / $5,433.20
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,941.65 / $2,772.78 / $3,447.89
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,241.40 / $18,867.00 / $36,111.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,731.11 / $2,491.11 / $3,291.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,016.00 / $22,200.84 / $36,636.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,505.00 / $2,054.06 / $3,648.63
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,057.60 / $1,057.60 / $1,353.73