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West Virginia 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
$440.75 / $577.74 / $2,300.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.76 / $577.74 / $716.78
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$447.68 / $490.04 / $585.30
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$520.27 / $520.27 / $520.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$785.77 / $785.77 / $785.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.57 / $751.14 / $2,192.09
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,791.03 / $11,791.03 / $11,791.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.29 / $785.46 / $1,001.27