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Washington, DC 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
$741.31 / $4,073.80 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $660.69 / $1,621.81
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $4,073.80 / $8,128.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $741.31 / $1,412.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $707.95 / $1,412.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $16,218.10 / $33,884.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $691.83 / $1,445.44