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West Virginia 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
$650.89 / $6,594.10 / $6,594.10
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,652.27 / $2,652.27 / $2,652.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.08 / $650.89 / $1,215.75
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$613.44 / $668.06 / $727.87
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.99 / $693.65 / $882.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$983.65 / $983.65 / $983.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$540.94 / $754.82 / $2,759.59
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,700.56 / $3,930.70 / $12,774.27
Highmark BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$1,340.28 / $1,340.28 / $2,081.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$543.67 / $766.73 / $1,072.97