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Utah 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
$1,047.13 / $3,715.35 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $851.14 / $3,548.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $933.25 / $1,621.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,412.54
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,348.96 / $2,754.23
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $1,258.93 / $1,698.24
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,047.13 / $1,659.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $724.44 / $1,148.15