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Nebraska 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
$1,288.25 / $7,943.28 / $13,489.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $645.65 / $2,570.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $8,128.31 / $15,848.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $812.83 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $1,096.48 / $1,819.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $851.14 / $8,709.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,258.93 / $4,570.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,412.54 / $1,819.70
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,348.96
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $812.83 / $1,621.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $7,413.10 / $9,120.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,000.00 / $1,479.11