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Washington rates for HCPCS 67904

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

Facilitymedian $1,738 · 10th–90th $912$14,4540%5%10%10th90th$1,738Professionalmedian $891 · 10th–90th $562$3,6310%5%10%10th90th$891$50.0$200.0$1.0K$5.0K$20.0K

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
$1,148.15 / $4,677.35 / $18,620.87
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$4,365.16 / $9,772.37 / $13,803.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $794.33 / $3,630.78
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$741.31 / $1,202.26 / $5,495.41
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $870.96
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,365.16 / $6,165.95 / $12,589.25
Asuris Northwest Health
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$6,606.93 / $9,332.54 / $19,054.61
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,412.54 / $1,995.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $912.01 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $1,122.02 / $2,089.30
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $1,288.25 / $2,290.87
Kaiser Permanente
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$5,754.40 / $9,332.54 / $16,595.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,288.25 / $1,949.84
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $436.52
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $1,412.54 / $1,445.44
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $977.24 / $1,000.00
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,258.93 / $1,819.70
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,265.80 / $6,456.54 / $12,589.25
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$6,456.54 / $9,772.37 / $19,054.61
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,412.54 / $1,995.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,288.25 / $6,918.31 / $13,182.57
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,000.00 / $1,819.70
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $891.25 / $1,621.81