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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
$566.64 / $3,294.00 / $7,679.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.64 / $708.99 / $1,133.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.96 / $736.44 / $1,125.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.01 / $387.62 / $586.18
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,413.68 / $11,103.62 / $16,181.16
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$669.16 / $944.54 / $1,219.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $7,693.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.73 / $825.44 / $1,282.33