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New York 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
$618.15 / $4,039.00 / $10,170.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.55 / $694.45 / $1,318.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,100.00 / $7,264.00 / $12,274.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$419.40 / $548.24 / $1,540.34
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.35 / $2,390.00 / $10,957.50
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.35 / $655.35 / $878.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$785.77 / $785.77 / $6,511.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.60 / $951.49 / $2,186.62
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $522.50 / $1,197.08
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.44 / $830.44 / $1,242.80
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$520.05 / $661.12 / $1,122.24
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $785.77 / $6,511.02
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.31 / $973.81 / $2,192.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,337.00 / $5,963.00 / $12,509.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.42 / $771.73 / $1,984.61
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.76 / $501.76 / $1,701.94
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.76 / $759.83 / $1,288.83