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Indiana rates for HCPCS 40702

Plastic repair of cleft lip/nasal deformity; primary bilateral, 1 of 2 stages

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,897.79 / $11,220.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,023.29 / $1,513.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $19,952.62 / $27,542.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,096.48 / $1,737.80
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,023.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,890.45 / $3,890.45 / $3,890.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,096.48 / $1,698.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $9,549.93 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $977.24 / $1,778.28