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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
$524.81 / $741.31 / $1,548.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $724.44 / $1,096.48
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,047.13 / $1,122.02
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,047.13 / $1,122.02
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $758.58 / $1,047.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $660.69 / $1,202.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $933.25 / $1,445.44