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New Hampshire 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
$1,949.84 / $2,398.83 / $14,791.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $741.31 / $1,445.44
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$1,380.38 / $1,380.38 / $3,311.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,737.80 / $3,019.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $977.24 / $1,548.82
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$758.58 / $1,479.11 / $2,344.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,230.27 / $1,778.28
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $9,549.93 / $9,549.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,071.52 / $2,041.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $9,549.93 / $9,549.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,023.29 / $2,137.96