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Pennsylvania rates for HCPCS 67901

Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$876.26 / $4,262.00 / $8,451.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,584.00 / $5,584.00 / $7,000.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$771.00 / $771.00 / $771.00
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,104.00 / $3,215.85 / $12,553.40
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,340.45 / $5,340.45 / $5,340.45
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $5,164.78 / $9,617.00
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,584.00 / $5,584.00 / $7,000.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$771.00 / $771.00 / $771.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$521.08 / $566.46 / $766.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.00 / $2,715.00 / $4,815.00