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South Dakota 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
$512.86 / $645.65 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $660.69 / $1,318.26
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$645.65 / $1,949.84 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,412.54 / $1,778.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $758.58 / $1,445.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $954.99 / $7,585.78
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,380.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $933.25 / $1,148.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $891.25 / $1,621.81
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,096.48 / $1,380.38