go back

Tennessee 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
$1,096.48 / $2,570.40 / $6,456.54
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$4,677.35 / $4,677.35 / $4,677.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $812.83 / $1,412.54
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$831.76 / $1,071.52 / $2,570.40
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $478.63 / $1,023.29
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$691.83 / $741.31 / $1,659.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $3,019.95 / $4,265.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $912.01 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $831.76 / $1,318.26
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $5,754.40 / $33,884.42
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,244.36 / $7,244.36 / $7,244.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $3,630.78 / $6,309.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $724.44 / $1,230.27