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South Carolina 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
$724.44 / $9,120.11 / $18,197.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $602.56 / $1,071.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $9,332.54 / $17,378.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $630.96 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $3,715.35 / $4,786.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $707.95 / $1,230.27
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $758.58 / $1,412.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $17,378.01 / $26,302.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $645.65 / $1,122.02