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Wisconsin rates for HCPCS 67904

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

Facilitymedian $4,786 · 10th–90th $1,122–$7,9430%10%20%10th90th$4,786Professionalmedian $977 · 10th–90th $575–$3,1620%10%10th90th$977$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$891.25 / $2,187.76 / $8,317.64
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$0.95 / $5,248.07 / $12,302.69
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $794.33 / $1,862.09
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$831.76 / $1,023.29 / $2,951.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,311.31 / $4,786.30 / $7,585.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $1,148.15 / $3,090.30
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$1,071.52 / $1,737.80 / $4,570.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,290.87 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,698.24 / $3,548.13
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $1,174.90 / $6,456.54
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,584.89 / $2,041.74
DeanCare
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$1,905.46 / $2,398.83 / $3,019.95
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $1,288.25 / $8,128.31
Medica
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$4,073.80 / $4,073.80 / $4,073.80
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,445.44 / $7,244.36
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $954.99
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $5,754.40 / $7,762.47
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $2,089.30 / $2,754.23
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,584.89 / $2,570.40
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,981.07 / $5,754.40 / $5,754.40
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $3,388.44 / $7,244.36
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,754.23 / $2,754.23 / $3,467.37
Security Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,235.94 / $3,235.94 / $3,235.94
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,691.53 / $5,754.40 / $7,244.36
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,786.30 / $7,413.10 / $9,120.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $1,621.81 / $4,466.84