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New Jersey 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
$516.70 / $5,982.00 / $11,298.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.33 / $545.20 / $871.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.58 / $850.10 / $1,932.83
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.44 / $924.26 / $1,138.27
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,382.16 / $16,352.10 / $31,187.56
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.65 / $663.15 / $1,058.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,682.00 / $9,969.00 / $19,696.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.82 / $668.82 / $1,341.09