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Indiana rates for HCPCS 40701

Plastic repair of cleft lip/nasal deformity; primary bilateral, 1-stage procedure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,159.63 / $4,580.00 / $17,225.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,050.30 / $1,159.63 / $1,634.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,427.00 / $11,294.00 / $22,813.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.09 / $1,403.40 / $2,084.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$958.21 / $1,395.72 / $1,507.44
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,073.63 / $1,288.35 / $1,525.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,909.74 / $3,909.74 / $3,909.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,011.72 / $1,382.64 / $2,042.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,699.00 / $10,000.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$937.07 / $1,193.19 / $2,180.55