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North Carolina 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
$707.95 / $3,090.30 / $8,709.64
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,818.38 / $4,897.79 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $812.83 / $1,819.70
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$831.76 / $1,047.13 / $2,570.40
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $537.03 / $1,288.25
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$794.33 / $1,047.13 / $1,862.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $707.95 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $831.76 / $1,698.24
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $794.33 / $1,348.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $7,244.36 / $10,471.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $707.95 / $1,412.54
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $5,754.40 / $33,884.42
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,244.36 / $7,244.36 / $7,244.36