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Massachusetts 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
$512.86 / $3,388.44 / $5,370.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $616.60 / $1,621.81
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $7,244.36 / $33,884.42
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $794.33 / $1,819.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $1,023.29 / $1,995.26
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $912.01 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $933.25 / $1,380.38
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,165.95 / $13,182.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $870.96 / $1,621.81
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $7,585.78 / $33,884.42
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $794.33 / $1,819.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,309.57 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $870.96 / $1,698.24