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Louisiana 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
$891.25 / $2,511.89 / $5,370.32
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,630.78 / $3,630.78 / $3,630.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $831.76 / $1,445.44
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$251.19 / $1,174.90 / $1,445.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $3,715.35 / $5,248.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $851.14 / $1,047.13
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $1,230.27 / $1,230.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $794.33 / $1,148.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $2,630.27 / $6,165.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $707.95 / $1,202.26