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Nebraska 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
$689.75 / $9,544.15 / $20,928.72
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$8,540.31 / $8,540.31 / $8,540.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.53 / $689.75 / $1,455.37
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$733.32 / $2,043.56 / $4,506.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,104.22 / $6,659.73 / $12,985.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.64 / $1,019.36 / $1,391.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,539.00 / $1,539.00 / $1,539.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.63 / $1,657.93 / $2,123.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.64 / $1,126.45 / $4,217.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,016.37 / $1,500.92 / $2,006.70
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,143.30 / $1,596.06 / $2,054.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,127.00 / $1,492.87 / $1,975.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,217.00 / $6,451.00 / $7,934.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,110.68 / $1,546.27 / $1,954.68