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New Hampshire 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
$1,778.28 / $2,398.83 / $14,791.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $588.84 / $1,412.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,623.41 / $8,912.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $794.33 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,023.29 / $1,737.80
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $11,220.18 / $11,220.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $870.96 / $1,621.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $11,220.18 / $11,220.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $933.25 / $1,659.59