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Utah rates for HCPCS 40761

Plastic repair of cleft lip/nasal deformity; with cross lip pedicle flap (Abbe-Estlander type), including sectioning and inserting of pedicle

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $5,888.44 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,174.90 / $3,090.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,348.96 / $1,819.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $7,413.10
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
$1,318.26 / $1,819.70 / $7,079.46
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,778.28 / $2,691.53
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,621.81 / $2,187.76
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
$912.01 / $1,096.48 / $1,621.81