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Pennsylvania 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
$1,255.59 / $5,254.00 / $10,398.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,050.30 / $1,186.65 / $1,885.40
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $28,970.26
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,188.09 / $1,232.94 / $2,194.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,011.72 / $1,306.01 / $2,183.42
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,420.01 / $1,825.73 / $1,889.52
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$784.02 / $784.02 / $784.02
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,301.00 / $5,526.00 / $11,083.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,051.81 / $1,255.64 / $6,296.01
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,327.10 / $1,327.10 / $1,395.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,340.26 / $1,340.26 / $1,340.26
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.08 / $1,363.33 / $2,366.36
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,161.20 / $1,161.20 / $1,446.75
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,161.20 / $1,166.90 / $1,446.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,843.00 / $3,879.00 / $7,508.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,030.55 / $1,326.28 / $2,293.42