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Hawaii 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
$1,949.84 / $5,495.41 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $741.31 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $831.76 / $954.99
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,202.26 / $7,413.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $870.96 / $1,047.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $831.76 / $1,230.27
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $2,630.27 / $6,606.93