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Washington, DC 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
$954.99 / $3,388.44 / $6,918.31
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,818.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $891.25 / $1,621.81
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$251.19 / $1,584.89 / $2,041.74
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,862.09 / $5,495.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $794.33 / $2,089.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,348.96 / $1,698.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $10,000.00 / $26,302.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $691.83 / $1,698.24