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Idaho 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
$3,422.00 / $4,500.00 / $8,622.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.71 / $954.28 / $1,505.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$650.12 / $867.50 / $1,108.47
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.30 / $1,027.72 / $1,521.63
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.40 / $909.58 / $1,193.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $78.00 / $1,076.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,660.78 / $14,097.25 / $17,807.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$872.34 / $932.93 / $1,219.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,120.00 / $22,317.00 / $27,159.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.91 / $846.46 / $1,373.14