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Maine 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
$588.84 / $588.84 / $776.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $691.83 / $1,202.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $676.08 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $776.25 / $1,122.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $776.25 / $1,202.26
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $758.58 / $1,737.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $812.83 / $1,202.26