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Pennsylvania rates for HCPCS 40654

Repair lip, full thickness; over one-half vertical height, or complex

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.57 / $3,623.00 / $7,799.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.84 / $566.34 / $846.68
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.69 / $3,159.00 / $14,886.03
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.51 / $599.29 / $599.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.85 / $572.05 / $924.66
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$697.88 / $897.28 / $926.42
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,733.47 / $2,733.47 / $4,585.56
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.87 / $572.87 / $572.87
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.00 / $3,839.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.64 / $624.57 / $1,630.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$584.50 / $584.50 / $618.60
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$722.07 / $722.07 / $722.07
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.80 / $586.92 / $977.23
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$415.75 / $488.82 / $569.10
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.51 / $523.17 / $610.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$814.00 / $2,391.00 / $4,789.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.70 / $638.40 / $1,096.13