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Maine 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
Professional
Modifier
Low / Median / High Price
$472.57 / $616.71 / $697.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.22 / $781.93 / $1,159.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.44 / $901.46 / $1,259.14
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$729.59 / $844.14 / $1,294.95
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.17 / $635.73 / $697.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.22 / $790.53 / $1,148.81