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Pennsylvania rates for HCPCS 64902

Nerve graft, each additional nerve; multiple strands (cable) (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$918.00 / $2,747.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.14 / $688.93 / $1,069.33
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$680.34 / $706.01 / $1,091.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$774.06 / $774.06 / $774.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.18 / $866.47 / $1,372.37
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.71 / $1,081.58 / $1,372.67
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.00 / $3,077.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$596.02 / $847.36 / $2,843.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$908.10 / $908.10 / $1,371.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$774.06 / $774.06 / $774.06
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.18 / $877.38 / $1,401.13
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$667.09 / $667.09 / $693.39
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.77 / $675.39 / $700.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.00 / $650.00 / $3,742.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$654.75 / $884.79 / $1,354.85