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South Dakota rates for HCPCS 21395

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

Facilitymedian $1,660 · 10th–90th $1,000–$6,9180%20%10th90th$1,660Professionalmedian $1,288 · 10th–90th $933–$2,5120%10%10th90th$1,288$1.0K$2.0K$5.0K$10.0K

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
$1,000.00 / $4,365.16 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,000.00 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,290.87 / $2,884.03
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,659.59 / $2,630.27
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,819.70 / $8,511.38
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,290.87 / $2,290.87
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,041.74 / $2,238.72
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,659.59 / $1,949.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,466.84 / $4,466.84 / $12,022.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,659.59 / $2,818.38
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,398.83 / $2,398.83