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Utah 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
$616.60 / $6,025.60 / $7,943.28
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$8,317.64 / $9,120.11 / $9,120.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $616.60 / $1,023.29
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$3,890.45 / $3,890.45 / $3,890.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $724.44 / $1,023.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,380.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,890.45 / $8,912.51
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,011.87 / $5,888.44 / $13,489.63
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $954.99 / $1,258.93
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $954.99 / $1,513.56
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $776.25 / $1,348.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $575.44 / $870.96