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Texas 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
$933.25 / $3,715.35 / $12,302.69
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,548.82 / $5,754.40 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $794.33 / $1,380.38
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$741.31 / $1,023.29 / $2,570.40
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$741.31 / $776.25 / $794.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $3,019.95 / $6,025.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $660.69 / $1,000.00
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $2,511.89 / $5,370.32
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $776.25 / $1,148.15
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $1,230.27 / $1,230.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,318.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $812.83 / $1,258.93
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $33,884.42 / $33,884.42
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,244.36 / $7,244.36 / $7,244.36
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $933.25 / $4,570.88
Moda Health
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,548.82 / $6,760.83 / $9,772.37
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $812.83 / $1,348.96
Moda Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$741.31 / $1,071.52 / $3,311.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $457.09 / $707.95
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $707.95 / $851.14
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $831.76 / $1,380.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $831.76 / $1,258.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $4,073.80 / $8,709.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $676.08 / $1,000.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $758.58 / $758.58