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Alaska rates for HCPCS 67904

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $9,772.37 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $912.01 / $3,235.94
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$831.76 / $1,548.82 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $912.01 / $2,344.23
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $933.25 / $3,981.07
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,905.46 / $3,162.28
Moda Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$831.76 / $1,548.82 / $2,398.83
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,951.21 / $3,801.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $954.99 / $4,677.35
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $691.83 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,584.89 / $5,754.40