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New York 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
$778.22 / $4,109.00 / $11,220.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,239.22 / $9,094.00 / $16,531.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.99 / $710.37 / $1,447.86
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$787.82 / $854.22 / $2,410.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,385.00 / $4,133.00 / $9,074.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$609.24 / $772.50 / $1,702.54
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$913.86 / $1,158.76 / $2,553.81
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.70 / $2,390.00 / $10,957.50
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.70 / $831.70 / $1,052.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$983.65 / $983.65 / $1,424.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.83 / $867.20 / $1,952.58
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.00 / $662.22 / $1,501.70
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.54 / $988.47 / $1,545.12
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.15 / $686.14 / $1,360.30
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$11,610.00 / $11,610.00 / $11,610.00
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$720.04 / $911.41 / $986.01
Highmark BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$827.78 / $1,080.06 / $1,091.94
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $983.65 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.02 / $900.31 / $1,952.77
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,652.00 / $4,370.00 / $9,187.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$627.54 / $830.88 / $1,857.74
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$806.37 / $806.37 / $1,565.25
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.15 / $1,005.24 / $1,565.25