Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
OPN TX ORBIT PERIORBT W/GRFT
Waco, TX
See all hospitals reporting CPT 21395 →Price type
Ascension Providence’s median price of $6.5k is 5% above the median hospital's median price ($6.2k), higher than 55% of the 1,452 hospitals reporting CPT 21395. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 1 payer, 4 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Blue Cross Blue Shield 872_blue cross blue shield myblueheath 20250101 fee schedule · outpatient | $3.9k | $3.9k | — | — | — | $3.9k – $3.9k |
| 2 | Blue Cross Blue Shield 871_blue cross blue shield advantage hmo 20250101 fee schedule · outpatient | $4.9k | $4.9k | — | — | — | $4.9k – $4.9k |
| 3 | Blue Cross Blue Shield 870_blue cross blue shield hmo essentials 20250101 fee schedule · outpatient | $8.2k | $8.2k | — | — | — | $8.2k – $8.2k |
| 4 | Blue Cross Blue Shield 869_blue cross blue shield ppo 20250101 fee schedule · outpatient | $9.2k | $9.2k | — | — | — | $9.2k – $9.2k |
Last updated: Jan 1, 2026
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