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Michigan 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
$616.60 / $4,897.79 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $602.56 / $977.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $436.52 / $707.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $660.69 / $933.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $1,862.09 / $6,918.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $691.83 / $977.24
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $691.83 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $7,585.78 / $13,489.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $676.08 / $954.99