go back

Repair Of A Cleft Lip Affecting Both Sides, Single Surgery

Washington 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 $3,631 · 10th–90th $1,660$22,9090%10%10th90th$3,631Professionalmedian $1,905 · 10th–90th $1,148$3,9810%20%10th90th$1,905$50.0$200.0$1.0K$5.0K$20.0K

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
$1,659.59
Median
$7,079.46
Typical High
$22,908.68
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,819.70
Typical High
$4,466.84
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$10,715.19
Median
$18,197.01
Typical High
$32,359.37
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$1,584.89
Median
$2,290.87
Typical High
$3,235.94
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,258.93
Median
$1,949.84
Typical High
$6,918.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,412.54
Median
$1,995.26
Typical High
$3,548.13
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$1,513.56
Median
$2,691.53
Typical High
$15,848.93
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,513.56
Median
$2,511.89
Typical High
$5,128.61
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$75.86
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$1,380.38
Median
$2,344.23
Typical High
$2,398.83
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,584.89
Median
$1,621.81
Typical High
$1,995.26
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,621.81
Median
$2,398.83
Typical High
$3,388.44
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$10,964.78
Median
$17,378.01
Typical High
$31,622.78
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$1,584.89
Median
$2,290.87
Typical High
$3,019.95
United
Setting
Facility
Modifier
Global
Typical Low
$3,467.37
Median
$17,782.79
Typical High
$33,884.42
United
Setting
Professional
Modifier
Global
Typical Low
$1,258.93
Median
$1,698.24
Typical High
$3,467.37
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,445.44
Typical High
$2,238.72