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South Carolina 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
$912.01 / $8,912.51 / $16,595.87
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,862.09 / $4,168.69 / $6,165.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $794.33 / $1,318.26
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$812.83 / $1,288.25 / $1,548.82
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$794.33 / $794.33 / $794.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $3,548.13 / $7,413.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $741.31 / $1,202.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $812.83 / $1,479.11
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $851.14 / $1,479.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $10,964.78 / $16,982.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $676.08 / $1,096.48