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Repair Of A Cleft Lip Affecting Both Sides, Single Surgery

South Dakota 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 $1,995 · 10th–90th $1,202$6,9180%10%10th90th$1,995Professionalmedian $1,995 · 10th–90th $1,000$3,3880%10%10th90th$1,995$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$4,365.16
Typical High
$6,918.31
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,071.52
Typical High
$1,995.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2,398.83
Median
$2,754.23
Typical High
$3,388.44
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,445.44
Median
$1,862.09
Typical High
$3,311.31
Medica
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$2,238.72
Typical High
$8,709.64
Midlands
Setting
Professional
Modifier
Global
Typical Low
$2,137.96
Median
$2,754.23
Typical High
$2,754.23
Midlands
Setting
Professional
Modifier
Global
Typical Low
$2,137.96
Median
$2,137.96
Typical High
$2,137.96
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,949.84
Typical High
$2,344.23
United
Setting
Facility
Modifier
Global
Typical Low
$4,466.84
Median
$4,466.84
Typical High
$12,022.64
United
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$2,137.96
Typical High
$3,311.31
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$2,238.72
Median
$2,344.23
Typical High
$2,691.53