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Repair Of A Cleft Lip Affecting Both Sides, Single Surgery

Hawaii rates for HCPCS 40701

This surgery repairs a cleft lip that affects both sides of the upper lip, correcting the separation and reshaping the lip and nose in one operation. It restores a more typical lip shape and function, and is usually performed on an infant. Repairing both sides together in a single procedure is chosen when the cleft on each side allows it.

Rates data updated July 2026.

Facilitymedian $8,511 · 10th–90th $2,570$8,5110%50%10th$8,511Professionalmedian $5,623 · 10th–90th $1,202$11,4820%5%10%10th90th$5,623$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$2,570.40
Median
$8,511.38
Typical High
$8,511.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,698.24
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,445.44
Typical High
$1,778.28
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,288.25
Typical High
$1,513.56
United
Setting
Facility
Modifier
Global
Typical Low
$3,019.95
Median
$3,019.95
Typical High
$3,019.95
United
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,288.25
Typical High
$1,621.81
University Health Alliance
Setting
Professional
Modifier
Global
Typical Low
$1,445.44
Median
$6,456.54
Typical High
$11,481.54