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Pennsylvania rates for HCPCS 67904

Repair of blepharoptosis; (tarso) levator resection or advancement, external approach

Facilitymedian $5,248 · 10th–90th $813–$8,5110%10%20%10th90th$5,248Professionalmedian $794 · 10th–90th $562–$1,9950%20%10th90th$794$10.0$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $5,011.87 / $8,511.38
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$5,128.61 / $6,025.60 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $724.44 / $1,445.44
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$794.33 / $1,071.52 / $4,466.84
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $602.56
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $6,165.95 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $741.31 / $1,318.26
Capital Blue Cross
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$1,071.52 / $1,122.02 / $1,949.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $676.08 / $676.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $724.44 / $1,174.90
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $912.01 / $1,258.93
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $776.25 / $1,230.27
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,090.30 / $6,165.95 / $10,471.29
Highmark BCBS
Facility/Professional
Facility
Modifier
22
Typical Low / Median / Typical High
$11,220.18 / $11,220.18 / $11,220.18
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$3,235.94 / $5,128.61 / $10,715.19
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $724.44 / $977.24
Highmark BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$1,071.52 / $1,071.52 / $1,479.11
Independence Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $602.56
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $3,801.89 / $8,317.64
Martin's Point
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$5,248.07 / $5,495.41 / $6,165.95
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $741.31 / $1,479.11
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $851.14 / $1,737.80
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $575.44 / $758.58
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $575.44 / $758.58
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $3,890.45 / $7,585.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $724.44 / $1,258.93