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Tennessee 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
$1,610.44 / $4,069.00 / $10,746.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.22 / $1,443.85 / $1,770.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,367.00 / $5,486.00 / $9,419.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,019.49 / $1,331.12 / $2,133.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,074.97 / $1,478.25 / $2,587.65
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,744.17 / $16,547.20 / $26,542.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,631.98 / $8,754.48 / $10,142.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,905.00 / $5,728.00 / $10,104.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,062.14 / $1,283.45 / $2,655.64