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Maryland 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
$2,818.38 / $2,951.21 / $4,570.88
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,819.70 / $3,801.89 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $851.14 / $1,862.09
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$251.19 / $977.24 / $2,041.74
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $616.60 / $758.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $630.96 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $691.83 / $1,412.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $870.96 / $1,258.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,621.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $645.65 / $1,202.26
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $831.76 / $1,230.27