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Wyoming rates for HCPCS 67904

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $794.33 / $3,630.78
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$831.76 / $831.76 / $1,548.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,388.44 / $3,548.13
BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$1,737.80 / $3,162.28 / $5,248.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $977.24 / $1,412.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $2,630.27 / $10,471.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,288.25 / $2,344.23