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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
$1,047.13 / $5,370.32 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $602.56 / $1,412.54
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $10,000.00 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $676.08 / $1,174.90
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $977.24 / $1,071.52
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $758.58 / $1,122.02
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,748.98 / $16,218.10 / $26,302.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $4,570.88 / $8,511.38
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $707.95 / $1,737.80
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $1,288.25
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $1,096.48 / $1,412.54
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $446.68 / $575.44
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $524.81 / $588.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,466.84 / $18,197.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $602.56 / $1,071.52