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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
$702.19 / $894.17 / $4,599.45
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,800.19 / $2,498.73 / $4,410.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.99 / $752.18 / $1,743.94
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$854.22 / $854.22 / $1,850.77
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$613.58 / $634.84 / $666.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$599.00 / $634.82 / $1,018.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.22 / $688.70 / $1,311.01
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$716.94 / $867.87 / $1,132.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,009.00 / $1,009.00 / $1,009.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$561.73 / $720.23 / $1,803.83
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.63 / $790.64 / $867.87