go back

South Dakota rates for HCPCS 30580

Repair Fistula Oromaxillary

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.83 / $653.57 / $653.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.66 / $528.79 / $1,440.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,068.93 / $1,336.16 / $1,774.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$598.67 / $893.66 / $1,680.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$773.75 / $1,683.47 / $4,551.12
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,015.00 / $1,417.22 / $5,105.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$929.00 / $1,235.82 / $1,634.40
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$628.69 / $909.54 / $1,193.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$773.75 / $1,130.69 / $1,758.85
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$866.40 / $1,060.09 / $1,391.10