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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
$4,241.22 / $10,431.19 / $20,928.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.51 / $570.97 / $2,527.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,193.47 / $8,393.75 / $15,757.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.20 / $808.33 / $1,157.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.28 / $1,417.22 / $1,838.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$548.90 / $935.56 / $7,363.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$829.16 / $1,456.27 / $4,551.12
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.28 / $1,417.04 / $5,251.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$965.16 / $1,280.83 / $1,656.44
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $742.10 / $1,610.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,178.00 / $7,441.00 / $8,816.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$829.16 / $1,380.56 / $1,749.98