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Washington rates for HCPCS 21395

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

Facilitymedian $2,570 · 10th–90th $1,288$21,8780%10%10th90th$2,570Professionalmedian $1,413 · 10th–90th $912$2,8180%10%20%10th90th$1,413$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
$1,905.46 / $9,772.37 / $24,547.09
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,288.25 / $2,511.89
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,715.19 / $15,488.17 / $31,622.78
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,995.26 / $2,754.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $1,659.59 / $3,019.95
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $2,041.74 / $7,079.46
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,949.84 / $5,370.32
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $407.38
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,949.84 / $2,041.74
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,380.38 / $1,778.28
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $2,041.74 / $2,630.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,715.19 / $16,218.10 / $31,622.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,949.84 / $2,754.23
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,467.37 / $17,378.01 / $33,884.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,445.44 / $2,630.27
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $1,023.29 / $1,862.09