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Alaska rates for HCPCS 30580

Repair fistula; oromaxillary (combine with 31030 if antrotomy is included)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,733.03 / $9,577.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,198.60 / $2,824.76 / $3,337.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,585.60 / $1,585.60 / $2,007.24
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$573.65 / $2,824.76 / $3,954.66
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,136.98 / $2,952.60 / $4,017.53
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,868.40 / $2,500.75 / $3,692.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$573.65 / $2,824.76 / $3,954.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.10 / $2,287.50 / $3,742.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.29 / $1,605.78 / $3,774.44