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South Dakota rates for HCPCS 67904

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

Facilitymedian $794 · 10th–90th $603–$4,3650%10%20%10th90th$794Professionalmedian $891 · 10th–90th $603–$2,6920%10%10th90th$891$500.0$1.0K$2.0K$5.0K

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
$630.96 / $794.33 / $4,365.16
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$2,344.23 / $2,344.23 / $2,344.23
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $794.33 / $2,691.53
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$831.76 / $831.76 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,737.80 / $2,187.76
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $870.96 / $1,778.28
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $1,174.90 / $2,290.87
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,698.24 / $1,778.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,148.15 / $1,412.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,691.53 / $2,691.53 / $4,897.79
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $1,230.27 / $1,995.26
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,380.38 / $1,698.24