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Michigan 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
$1,518.08 / $4,933.00 / $6,906.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,051.81 / $1,518.08 / $1,885.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,802.84 / $5,597.88 / $7,584.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.22 / $1,199.89 / $2,422.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$981.70 / $1,307.38 / $4,658.20
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,195.15 / $4,933.00 / $6,906.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,195.15 / $1,292.59 / $1,888.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.69 / $953.37 / $1,409.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,636.84 / $7,800.00 / $10,652.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.48 / $1,499.30 / $1,929.48