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Utah 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
$618.51 / $4,312.00 / $7,679.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,201.37 / $5,874.45 / $7,126.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$592.29 / $747.04 / $1,594.68
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$2,479.34 / $2,479.34 / $2,479.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.15 / $906.59 / $1,244.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.16 / $426.85 / $674.93
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,310.39 / $4,430.70 / $6,456.79
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$4,965.59 / $6,646.05 / $9,685.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$823.73 / $1,051.97 / $1,425.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,981.00 / $3,613.00 / $7,048.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$609.12 / $732.20 / $1,066.91