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Montana rates for HCPCS 67904

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,080.16 / $3,080.16 / $3,080.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.87 / $633.30 / $2,700.00
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$733.32 / $835.47 / $4,506.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$930.14 / $930.14 / $1,163.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$930.14 / $930.14 / $930.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.53 / $753.68 / $1,202.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.21 / $930.14 / $1,539.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$603.55 / $882.98 / $1,202.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,450.00 / $1,450.00 / $1,450.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,087.83 / $1,213.34 / $1,401.63