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
Los Angeles, CA
See all hospitals reporting CPT 21395 →Price type
Dignity Community Care’s median price of $7.5k is 21% above the median hospital's median price ($6.2k), higher than 69% 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: 6 payers, 15 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 | Kaiser medicaid|< 21 fee schedule · outpatient | $1.2k | $1.2k | — | — | — | $1.2k – $1.2k |
| 2 | Kaiser medicaid|> 21 fee schedule · outpatient | $1.2k | $1.2k | — | — | — | $1.2k – $1.2k |
| 3 | Anthem medicaid|all plans fee schedule · outpatient | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 4 | Molina medicaid|< 21 fee schedule · outpatient | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 5 | Molina medicaid|> 21 fee schedule · outpatient | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 6 | Blue Cross Blue Shield commercial|exchange case rate · outpatient | $2.8k | $2.8k | — | — | — | $2.8k – $2.8k |
| 7 | Blue Cross Blue Shield medicaid|all plans fee schedule · outpatient | $6.4k | $6.4k | — | — | — | $6.4k – $6.4k |
| 8 | Aetna medicare|all plans fee schedule · outpatient | $7.5k | $7.5k | — | — | — | $7.5k – $7.5k |
| 9 | Anthem medicare|all plans fee schedule · outpatient | $7.5k | $7.5k | — | — | — | $7.5k – $7.5k |
| 10 | Blue Cross Blue Shield medicare|all other plans case rate · outpatient | $7.5k | $7.5k | — | — | — | $7.5k – $7.5k |
| 11 | Molina medicare|all plans fee schedule · outpatient | $7.5k | $7.5k | — | — | — | $7.5k – $7.5k |
| 12 | UnitedHealthcare medicare|all plans case rate · outpatient | $7.5k | $7.5k | — | — | — | $7.5k – $7.5k |
| 13 | Anthem commercial|exchange case rate · outpatient | $15.6k | $15.6k | — | — | — | $15.6k – $15.6k |
| 14 | Anthem commercial|all other plans case rate · outpatient | $23.6k | $23.6k | — | — | — | $23.6k – $23.6k |
| 15 | Anthem commercial|mcs case rate · outpatient | $29.0k | $29.0k | — | — | — | $29.0k – $29.0k |
Last updated: Feb 28, 2026
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