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Missouri 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
$1,548.82 / $4,073.80 / $8,511.38
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,467.37 / $8,709.64 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $794.33 / $1,698.24
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$794.33 / $1,202.26 / $2,570.40
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$1,380.38 / $1,380.38 / $1,380.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $4,677.35 / $8,912.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $741.31 / $1,023.29
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$812.83 / $1,122.02 / $1,548.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $758.58 / $1,023.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $1,148.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $812.83 / $1,698.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $1,659.59 / $26,302.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $954.99 / $7,244.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $2,398.83 / $4,677.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $741.31 / $1,230.27