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Utah 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
$707.95 / $4,570.88 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $645.65 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $741.31 / $1,047.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,445.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $10,000.00 / $22,387.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $977.24 / $1,412.54
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $891.25 / $1,548.82
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $812.83 / $1,348.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $645.65 / $1,122.02