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Pennsylvania rates for HCPCS 67903

Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.96 / $3,830.00 / $8,240.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.62 / $575.24 / $911.56
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$1,141.71 / $1,181.43 / $1,492.96
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$672.31 / $672.31 / $672.31
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$584.88 / $606.95 / $1,061.01
Capital Blue Cross
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$877.31 / $910.42 / $1,591.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$678.00 / $678.00 / $678.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.13 / $579.36 / $917.24
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.85 / $711.85 / $917.94
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,686.12 / $5,021.88 / $8,246.29
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,215.85 / $4,855.64 / $5,589.78
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.10 / $586.32 / $729.67
Highmark BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$814.49 / $865.65 / $1,101.05
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$976.00 / $4,597.00 / $8,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.02 / $590.23 / $1,612.84
Martin's Point
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$1,141.71 / $1,181.43 / $1,492.96
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$779.40 / $779.40 / $779.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$678.00 / $678.00 / $678.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.64 / $579.25 / $914.75
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$460.43 / $516.59 / $630.41
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.09 / $570.79 / $630.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.00 / $2,884.00 / $6,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$517.07 / $678.62 / $1,105.07