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New Mexico 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
$532.47 / $2,095.00 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$456.69 / $629.78 / $977.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,345.93 / $14,509.34 / $23,263.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.81 / $717.09 / $1,021.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$584.30 / $814.34 / $1,074.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $514.01 / $926.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.14 / $622.54 / $873.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.96 / $814.34 / $1,165.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,315.00 / $11,259.00 / $12,494.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$740.00 / $900.03 / $1,442.62