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Arizona 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
$1,965.00 / $4,521.00 / $7,960.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$479.63 / $640.71 / $2,527.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$830.45 / $3,106.86 / $5,113.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.64 / $433.62 / $569.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,374.52 / $5,374.52 / $5,374.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$455.06 / $664.00 / $1,189.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$503.73 / $722.82 / $6,477.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.65 / $794.25 / $4,551.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,613.00 / $6,477.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$545.49 / $658.98 / $1,178.68