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Maine rates for HCPCS 40701

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,412.54 / $3,235.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,698.24 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,659.59 / $2,691.53
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,513.56 / $2,344.23
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,778.28 / $4,168.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,479.11 / $2,344.23