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Indiana 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
$456.80 / $1,030.00 / $14,063.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.31 / $565.55 / $676.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,719.00 / $8,512.00 / $16,307.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$473.75 / $592.19 / $817.22
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$435.17 / $554.63 / $755.47
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.57 / $639.80 / $836.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,909.74 / $3,909.74 / $3,909.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.28 / $656.54 / $1,322.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,699.00 / $10,000.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.17 / $739.02 / $1,102.56