Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
PR Repair of Blepharoptosis Levator Resection/Advancement External Approach
Troy, NY
See all hospitals reporting CPT 67904 →Price type
Samaritan Hospital’s median price of $8.2k is 202% above the median hospital's median price ($2.7k), higher than 95% of the 1,685 hospitals reporting CPT 67904. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 13 payers, 34 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Anthem empire medicaid facility · fee schedule · outpatient | $9 | $9 | $0 | 4% | — | $8 – $9 |
| 2 | Anthem empire medicaid essential 1 2 3 4 facility · fee schedule · outpatient | $9 | $9 | $0 | 4% | — | $8 – $9 |
| 3 | Excellus empire medicaid facility · fee schedule · outpatient | $9 | $9 | $0 | 4% | — | $8 – $9 |
| 4 | Excellus empire medicaid essential 1 2 3 4 facility · fee schedule · outpatient | $9 | $9 | $0 | 4% | — | $8 – $9 |
| 5 | UnitedHealthcare united healthcare medicaid harp chip facility · fee schedule · outpatient | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 6 | Anthem empire bcbs medicare advantage facility · other · outpatient | $2.9k | $2.9k | — | — | 1–10 | $2.9k – $2.9k |
| 7 | UnitedHealthcare united healthcare medicare advantage facility · other · outpatient | $3.0k | $3.0k | — | — | — | $3.0k – $3.0k |
| 8 | Aetna aetna medicare advantage facility · other · outpatient | $3.1k | $3.1k | — | — | 1–10 | $3.1k – $3.1k |
| 9 | WellCare wellcare medicare advantage facility · other · outpatient | $3.2k | $3.2k | — | — | — | $3.2k – $3.2k |
| 10 | Excellus blue shield of ne new york medicare adv facility · other · outpatient | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
| 11 | Highmark blue shield of ne new york medicare adv facility · other · outpatient | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
| 12 | WellCare wellcare ep 1&2 medicaid facility · other · outpatient | $4.7k | $4.7k | — | — | — | $4.7k – $4.7k |
| 13 | Highmark blue shield of ne new york ascend facility · other · outpatient | $4.8k | $4.8k | — | — | — | $4.8k – $4.8k |
| 14 | UnitedHealthcare uhc essential plan medicaid facility · fee schedule · outpatient | $5.3k | $5.3k | — | — | — | $5.3k – $5.3k |
| 15 | Anthem empire bcbs blue access facility · other · outpatient | $6.1k | $6.1k | — | — | — | $6.1k – $6.1k |
| 16 | Anthem empire bcbs hmo epo ppo indemnity facility · other · outpatient | $6.8k | $6.8k | — | — | — | $6.8k – $6.8k |
| 17 | Blue Cross Blue Shield empire bcbs hmo epo ppo indemnity facility · other · outpatient | $6.8k | $6.8k | — | — | — | $6.8k – $6.8k |
| 18 | UnitedHealthcare empire bcbs hmo epo ppo indemnity facility · other · outpatient | $6.8k | $6.8k | — | — | — | $6.8k – $6.8k |
| 19 | Wellmark empire bcbs hmo epo ppo indemnity facility · other · outpatient | $6.8k | $6.8k | — | — | — | $6.8k – $6.8k |
| 20 | Blue Cross Blue Shield blue shield of ne new york hmo facility · other · outpatient | $8.2k | $8.2k | $1.6k | 20% | — | $6.6k – $9.8k |
| 21 | Carefirst blue shield of ne new york hmo facility · other · outpatient | $8.2k | $8.2k | $1.6k | 20% | — | $6.6k – $9.8k |
| 22 | Highmark blue shield of ne new york hmo facility · other · outpatient | $8.2k | $8.2k | $1.6k | 20% | — | $6.6k – $9.8k |
| 23 | Wellmark blue shield of ne new york hmo facility · other · outpatient | $8.2k | $8.2k | $1.6k | 20% | — | $6.6k – $9.8k |
| 24 | Cigna cigna facility · fee schedule · outpatient | $9.0k | $9.0k | — | — | — | $9.0k – $9.0k |
| 25 | UnitedHealthcare united healthcare facility · other · outpatient | $9.6k | $9.6k | $3.2k | 33% | — | $6.4k – $12.8k |
Last updated: Mar 31, 2026
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