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Repair Of A Cleft Lip Affecting Both Sides, Single Surgery

Wisconsin 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 $10,233 · 10th–90th $3,467$16,9820%5%10%10th90th$10,233Professionalmedian $1,995 · 10th–90th $1,148$5,2480%10%10th90th$1,995$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
$1,288.25
Median
$2,398.83
Typical High
$14,454.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,288.25
Typical High
$4,466.84
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$6,606.93
Median
$10,964.78
Typical High
$18,197.01
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$2,238.72
Typical High
$6,760.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3,090.30
Median
$3,630.78
Typical High
$5,754.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,258.93
Median
$2,398.83
Typical High
$4,897.79
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$3,388.44
Typical High
$5,754.40
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$2,089.30
Median
$2,884.03
Typical High
$3,630.78
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,288.25
Median
$3,467.37
Typical High
$15,135.61
Medica
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,949.84
Typical High
$6,456.54
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$1,548.82
Network Health
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$9,332.54
Typical High
$15,848.93
Network Health
Setting
Professional
Modifier
Global
Typical Low
$1,621.81
Median
$2,951.21
Typical High
$4,570.88
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$1,122.02
Median
$1,548.82
Typical High
$3,388.44
Quartz
Setting
Professional
Modifier
Global
Typical Low
$1,862.09
Median
$2,570.40
Typical High
$3,715.35
Quartz
Setting
Facility
Modifier
Global
Typical Low
$11,748.98
Median
$16,982.44
Typical High
$16,982.44
Quartz
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$2,089.30
Typical High
$8,912.51
Security Health
Setting
Professional
Modifier
Global
Typical Low
$4,265.80
Median
$4,265.80
Typical High
$4,265.80
Security Health
Setting
Professional
Modifier
Global
Typical Low
$4,265.80
Median
$5,888.44
Typical High
$6,606.93
United
Setting
Facility
Modifier
Global
Typical Low
$5,248.07
Median
$12,302.69
Typical High
$15,848.93
United
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,819.70
Typical High
$5,128.61