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Missouri 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
$599.59 / $4,610.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.77 / $559.20 / $676.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,247.00 / $9,663.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.45 / $639.17 / $922.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.60 / $771.29 / $1,325.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.94 / $904.87 / $5,504.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$653.89 / $1,202.22 / $4,551.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,156.00 / $4,000.00 / $10,781.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$634.58 / $844.47 / $1,362.42