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Montana rates for HCPCS 21395

Open treatment of orbital floor blowout fracture; periorbital approach with bone graft (includes obtaining graft)

Facilitymedian $1,738 · 10th–90th $1,318–$2,0890%20%40%10th90th$1,738Professionalmedian $1,413 · 10th–90th $977–$2,5120%10%10th90th$1,413$100.0$200.0$500.0$1.0K$2.0K$5.0K$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
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,380.38 / $2,754.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,584.89 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,288.25 / $1,698.24
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,737.80 / $2,089.30
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,737.80 / $2,089.30
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,412.54 / $2,041.74
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $1,380.38 / $2,089.30
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,174.90 / $12,022.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,659.59 / $2,089.30