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California rates for HCPCS 67904

Rpr Blepharoptosis Levator Rescj/Advmnt Xtrnl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$810.00 / $7,631.00 / $17,343.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$644.77 / $6,903.13 / $16,432.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.88 / $653.38 / $1,453.57
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$787.82 / $980.07 / $4,506.14
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.69 / $551.69 / $584.53
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$798.43 / $843.12 / $1,075.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,275.00 / $8,441.00 / $16,676.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.07 / $840.56 / $1,654.40
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$955.68 / $1,081.06 / $1,220.54
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.70 / $100.00 / $10,377.87
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.87 / $668.39 / $1,345.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.31 / $1,458.73 / $1,988.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.34 / $813.60 / $1,591.17
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.64 / $900.45 / $1,215.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.29 / $811.51 / $1,449.98
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,054.44 / $4,169.04 / $26,542.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,208.00 / $7,208.00 / $7,208.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$685.78 / $900.80 / $1,363.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.17 / $871.41 / $1,720.83
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,954.24 / $1,954.24 / $2,439.91
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.57 / $818.91 / $1,138.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,190.00 / $7,352.00 / $14,743.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.84 / $732.20 / $1,864.59