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Repair Of A Cleft Lip Affecting Both Sides, Single Surgery

Pennsylvania 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 $6,918 · 10th–90th $1,413$11,2200%10%10th90th$6,918Professionalmedian $1,230 · 10th–90th $1,047$2,3440%20%10th90th$1,230$500.0$1.0K$2.0K$5.0K$10.0K$20.0K$50.0K

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
$1,412.54
Median
$7,244.36
Typical High
$10,964.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,230.27
Typical High
$2,454.71
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$9,549.93
Median
$10,000.00
Typical High
$57,543.99
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,778.28
Typical High
$2,187.76
Cigna
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$1,288.25
Typical High
$2,041.74
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1,819.70
Median
$1,819.70
Typical High
$1,819.70
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,445.44
Typical High
$2,137.96
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$776.25
Median
$776.25
Typical High
$776.25
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$1,288.25
Median
$5,495.41
Typical High
$11,220.18
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,348.96
Typical High
$6,456.54
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$1,318.26
Median
$1,318.26
Typical High
$1,380.38
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$1,445.44
Median
$4,786.30
Typical High
$8,317.64
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,174.90
Typical High
$1,445.44
United
Setting
Facility
Modifier
Global
Typical Low
$2,454.71
Median
$5,370.32
Typical High
$17,378.01
United
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,318.26
Typical High
$2,290.87