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Utah 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
$1,096.48 / $5,888.44 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,023.29 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,258.93 / $1,659.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $3,467.37
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $10,000.00 / $22,387.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,548.82 / $3,311.31
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,659.59 / $2,511.89
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,513.56 / $1,995.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,023.29 / $1,445.44