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Montana 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
$588.04 / $786.96 / $3,094.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$924.36 / $924.36 / $924.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.39 / $924.36 / $944.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$456.83 / $628.14 / $924.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$565.48 / $924.36 / $1,223.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$844.06 / $987.24 / $1,097.74