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Georgia 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
$776.25 / $4,786.30 / $7,413.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $645.65 / $1,174.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $3,388.44 / $6,918.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $758.58 / $1,096.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $870.96 / $1,380.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $707.95 / $1,202.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $6,918.31 / $12,022.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $741.31 / $1,288.25