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Minnesota 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
$489.78 / $645.65 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $630.96 / $977.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $11,481.54 / $26,915.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,202.26 / $2,089.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $2,290.87 / $5,370.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,698.24 / $2,691.53
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $2,187.76 / $4,265.80
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,548.82 / $2,454.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $977.24 / $10,471.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,348.96 / $3,548.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $9,120.11 / $14,791.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,174.90 / $2,238.72