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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
$853.00 / $2,678.00 / $7,602.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,856.50 / $3,856.50 / $4,627.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.82 / $771.14 / $1,049.90
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$825.57 / $825.57 / $2,558.83
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$422.15 / $422.15 / $844.29
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$798.43 / $798.43 / $982.32
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,660.00 / $2,875.00 / $4,235.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.35 / $832.92 / $1,722.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.04 / $808.98 / $1,311.84
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,054.44 / $4,169.04 / $26,542.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,208.00 / $7,208.00 / $7,208.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,750.00 / $3,626.00 / $6,291.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.74 / $792.74 / $1,430.96