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Utah rates for HCPCS 21395

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

Facilitymedian $6,026 · 10th–90th $3,162–$12,0230%10%10th90th$6,026Professionalmedian $1,380 · 10th–90th $912–$5,4950%10%10th90th$1,380$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
$1,380.38 / $6,025.60 / $10,232.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,380.38 / $6,165.95
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,348.96 / $2,137.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $1,778.28
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,511.38 / $11,481.54 / $17,782.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,659.59 / $2,570.40
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,862.09 / $2,454.71
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,445.44 / $2,187.76
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,047.13 / $1,698.24