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South Dakota 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
$489.78 / $645.65 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $575.44 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,380.38 / $1,819.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $812.83 / $1,698.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $1,202.26 / $4,570.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,122.02 / $1,445.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $977.24 / $1,288.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $954.99 / $1,202.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,000.00 / $1,698.24
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,071.52 / $1,380.38