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Texas rates for HCPCS 67912

Correction of lagophthalmos, with implantation of upper eyelid lid load (eg, gold weight)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$747.00 / $3,078.00 / $10,234.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,666.44 / $3,057.62 / $6,214.00
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$469.56 / $2,243.65 / $8,100.00
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$413.81 / $413.81 / $904.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,263.04 / $1,263.04 / $1,304.32
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,302.40 / $26,542.00 / $26,542.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$484.47 / $890.05 / $1,412.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$484.47 / $897.19 / $1,448.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,120.00 / $3,264.00 / $7,600.00