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Montana 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
$503.61 / $2,527.80 / $3,337.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$727.71 / $727.71 / $727.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$658.76 / $854.38 / $1,088.92
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$454.29 / $1,049.09 / $1,160.01
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.33 / $732.77 / $1,088.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$837.07 / $1,049.09 / $1,692.76