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Utah rates for HCPCS 67904

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

Facilitymedian $4,898 · 10th–90th $741$7,9430%10%20%10th90th$4,898Professionalmedian $794 · 10th–90th $562$1,6600%10%10th90th$794$50.0$200.0$1.0K$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
$741.31 / $5,495.41 / $9,120.11
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$2,187.76 / $3,548.13 / $7,079.46
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $758.58 / $1,659.59
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$831.76 / $831.76 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $851.14 / $1,230.27
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $1,698.24
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,311.31 / $4,570.88 / $6,918.31
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$5,011.87 / $6,918.31 / $10,471.29
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,122.02 / $1,548.82
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $1,174.90 / $1,862.09
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $954.99 / $1,445.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $4,897.79 / $7,079.46
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $707.95 / $1,071.52