go back

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
$3,388.44 / $4,466.84 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $794.33 / $1,513.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $6,918.31 / $15,135.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,000.00 / $1,230.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $851.14 / $1,096.48
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $1,047.13 / $2,137.96
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $891.25 / $1,258.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $77.62
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $13,182.57 / $18,620.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $977.24 / $1,288.25
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $870.96 / $12,589.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,232.93 / $22,387.21 / $27,542.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $776.25 / $1,174.90