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Maryland rates for HCPCS 30580

Repair fistula; oromaxillary (combine with 31030 if antrotomy is included)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $660.69 / $1,513.56
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $489.78 / $588.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $3,090.30 / $3,090.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $758.58 / $1,412.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $758.58 / $1,122.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $2,884.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $676.08 / $1,122.02
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $851.14 / $977.24