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Wisconsin rates for HCPCS 21395

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

Facilitymedian $10,471 · 10th–90th $3,020–$20,4170%5%10%10th90th$10,471Professionalmedian $1,445 · 10th–90th $933–$4,4670%10%20%10th90th$1,445$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
$977.24 / $2,041.74 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,000.00 / $2,511.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,760.83 / $10,964.78 / $20,417.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $2,041.74 / $5,248.07
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,570.40 / $3,019.95 / $4,786.30
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $4,073.80 / $4,570.88
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $2,041.74 / $10,232.93
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,398.83 / $3,090.30
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $2,089.30 / $15,135.61
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,819.70 / $8,511.38
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $9,332.54 / $15,848.93
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $2,344.23 / $4,168.69
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $2,137.96 / $3,162.28
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9,120.11 / $13,803.84 / $13,803.84
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $4,897.79 / $8,511.38
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,235.94 / $3,235.94 / $3,235.94
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,235.94 / $5,495.41 / $6,309.57
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,585.78 / $12,022.64 / $15,848.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,513.56 / $4,073.80