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Ohio rates for HCPCS 30580

Repair fistula; oromaxillary (combine with 31030 if antrotomy is included)

Facilitymedian $5,129 · 10th–90th $692$12,0230%5%10%10th90th$5,129Professionalmedian $603 · 10th–90th $447$1,3180%20%10th90th$603$5.0$20.0$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $5,128.61 / $11,748.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $602.56 / $1,621.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $4,365.16 / $16,982.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $549.54 / $977.24
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $467.74 / $524.81
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $707.95 / $1,174.90
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $707.95 / $1,174.90
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $218.78
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $7,244.36
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $645.65 / $1,174.90
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,168.69 / $6,606.93 / $13,489.63
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $630.96 / $1,023.29