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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
$851.14 / $4,073.80 / $11,748.98
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,248.07 / $7,413.10 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $794.33 / $1,905.46
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$794.33 / $1,023.29 / $2,818.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $4,786.30 / $10,232.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $776.25 / $1,862.09
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$912.01 / $1,148.15 / $2,754.23
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $2,398.83 / $10,964.78
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $831.76 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,412.54 / $50,118.72
Cigna
Facility/Professional
Facility
Modifier
22
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $891.25 / $2,137.96
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $707.95 / $1,949.84
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,047.13 / $1,621.81
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $891.25 / $1,548.82
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$11,481.54 / $11,481.54 / $11,481.54
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $724.44 / $912.01
Highmark BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$831.76 / $1,096.48 / $1,096.48
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $912.01 / $1,513.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $4,265.80 / $9,549.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $707.95 / $1,548.82
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $812.83 / $1,548.82
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $812.83 / $2,398.83