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Indiana rates for HCPCS 64901

Nerve graft, each additional nerve; single strand (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$541.96 / $1,941.00 / $7,212.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.39 / $541.96 / $741.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,804.00 / $4,417.00 / $7,761.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.20 / $921.60 / $1,244.16
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$523.92 / $681.11 / $785.90
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.92 / $628.72 / $785.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$608.91 / $771.26 / $1,262.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.00 / $2,252.00 / $4,426.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.42 / $673.52 / $1,141.58