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North Dakota 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
$597.48 / $743.29 / $8,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.87 / $630.36 / $798.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,163.82 / $1,441.96 / $1,696.42
BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$1,745.73 / $2,116.35 / $2,544.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.41 / $1,234.75 / $1,929.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.48 / $992.05 / $1,594.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.49 / $1,319.42 / $1,943.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,545.00 / $2,545.00 / $2,545.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.49 / $1,172.82 / $1,750.37