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Maine rates for HCPCS 67904

Repair of blepharoptosis; (tarso) levator resection or advancement, external approach

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $741.31 / $1,445.44
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$794.33 / $977.24 / $977.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $831.76 / $977.24
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$758.58 / $1,258.93 / $1,479.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,148.15 / $1,548.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $912.01 / $1,412.54
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $912.01 / $1,659.59
Martin's Point
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$794.33 / $977.24 / $2,041.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $912.01 / $1,318.26