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Pennsylvania 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
$658.71 / $3,964.00 / $8,451.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.30 / $573.48 / $796.05
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $28,970.26
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$603.60 / $626.37 / $626.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.71 / $701.61 / $1,160.91
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.87 / $951.10 / $974.68
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,630.66 / $14,224.60 / $26,515.87
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$976.00 / $4,761.00 / $8,404.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.31 / $643.24 / $1,956.36
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $586.40 / $1,610.90
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.46 / $705.54 / $1,188.82
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.88 / $450.02 / $593.55
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.07 / $530.50 / $633.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,332.00 / $3,914.00 / $7,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.59 / $729.20 / $1,231.07