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Pennsylvania rates for HCPCS 21395

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

Facilitymedian $7,244 · 10th–90th $1,445–$11,2200%10%10th90th$7,244Professionalmedian $1,047 · 10th–90th $891–$2,0420%20%10th90th$1,047$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$1,445.44 / $7,244.36 / $11,220.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,023.29 / $2,187.76
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20,417.38 / $21,379.62 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,047.13 / $1,862.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,174.90 / $1,995.26
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,445.44 / $1,819.70
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,122.02 / $1,659.59
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $5,248.07 / $10,964.78
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,023.29 / $2,290.87
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,479.11 / $2,089.30
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $933.25 / $977.24
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $933.25 / $1,000.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $5,754.40 / $19,054.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,122.02 / $2,041.74