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Texas 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
$705.89 / $3,445.00 / $10,836.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.98 / $599.59 / $817.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,997.44 / $7,275.80 / $14,454.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.73 / $586.17 / $971.55
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.37 / $223.37 / $410.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,187.68 / $4,187.68 / $4,187.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.61 / $711.40 / $1,149.05
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,213.06 / $26,542.00 / $26,542.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,413.12 / $4,460.56 / $5,134.80
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.35 / $705.89 / $1,322.64
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.23 / $775.83 / $1,074.22
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$667.80 / $667.80 / $667.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.35 / $716.41 / $1,335.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$520.36 / $734.98 / $1,279.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,093.00 / $6,000.00 / $13,134.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.21 / $707.04 / $1,127.59
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$509.34 / $575.96 / $808.49