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Rhode Island 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
$3,019.95 / $3,715.35 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $676.08 / $1,412.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $549.54 / $1,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $758.58 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $7,413.10 / $13,182.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $691.83 / $1,174.90