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Michigan 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
$4,073.80 / $4,073.80 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,047.13 / $1,995.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $1,513.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,513.56 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,096.48 / $4,168.69
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $4,073.80 / $5,754.40
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,047.13 / $1,445.44
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,023.29 / $3,890.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $7,585.78 / $13,489.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,122.02 / $1,479.11