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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
$1,513.56 / $7,585.78 / $13,489.63
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$8,511.38 / $8,511.38 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $794.33 / $3,311.31
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$741.31 / $1,380.38 / $4,466.84
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$1,949.84 / $1,949.84 / $1,949.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $6,606.93 / $12,882.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,023.29 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,737.80 / $2,187.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $1,174.90 / $4,265.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,380.38 / $1,995.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,698.24 / $2,137.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,621.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,621.81 / $1,819.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $4,365.16 / $8,128.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,258.93 / $1,737.80