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Kentucky 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
$436.61 / $606.75 / $8,229.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.61 / $570.91 / $844.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $3,967.00 / $8,800.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.53 / $496.25 / $692.31
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.92 / $597.87 / $689.68
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$491.11 / $608.07 / $960.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$535.12 / $785.77 / $785.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$491.20 / $702.43 / $1,208.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$842.00 / $4,539.00 / $10,113.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.49 / $760.71 / $1,171.92