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Tennessee 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
$853.00 / $2,678.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.52 / $571.96 / $863.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,695.00 / $5,579.00 / $9,419.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.87 / $696.93 / $1,232.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.17 / $750.36 / $1,195.74
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,213.06 / $3,253.62 / $26,542.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,413.12 / $4,460.56 / $5,134.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,799.00 / $5,728.00 / $10,111.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.16 / $876.64 / $1,440.37