Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 21406 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Open Treatment Of Fracture Of, Open Treatment Of Fracture Of Orbit Except Blowout Withoutimplant Open Treatment Of Fracture Of Orbit Except Blowout Without
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None LT - Left side of body 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21406 |
| Medicaid Fee Schedule | View Medicaid rates for 21406 |
National average reimbursement for CPT 21406 by major payers:
$783.24
$759.04
$804.27
$941.22
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 21406.
CPT 21406
5 of 25 sample ratesHigher to lower in this preview
Riva Road Surgical Center, LLC
Riva Road Surgical Center LLC
$6,286.00Published rateAlegent Creighton Health, Chi Health Ambulatory Surgery Center At Midlands
Alegent Creighton Health
$4,712.35Published rateBrentwood Surgery Center, LLC, Brentwood Surgery Center
$3,067.00Published rateSurgery Center Partners. LLC, Timberlake Surgery Center
Surgery Center Partners LLC
$2,200.00Published rateBrunswick Endoscopy Center, LLC
Brunswick Endoscopy Center LLC
$835.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 21406 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21406 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 21406 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 21400-CPT | Moderate | Closed Treatment Of Fracture O, Closed Treatment Of Fracture Of Orbit Except Blowoutwithout Manipulation Closed Treatment Of Fracture Of Orbit Except Blowout |
| 21406-CPT | Moderate | Open Treatment Of Fracture Of, Open Treatment Of Fracture Of Orbit Except Blowout Withoutimplant Open Treatment Of Fracture Of Orbit Except Blowout Without |
| 21407-CPT | Moderate | Open Treatment Of Fracture Of, Open Treatment Of Fracture Of Orbit Except Blowout With Implant Open Treatment Of Fracture Of Orbit Except Blowout With |
| 21408-CPT | High | Open Treatment Of Fracture Of, Open Treatment Of Fracture Of Orbit Except Blowout With Bone Grafting (Includes Obtaining Graft)Open Treatment Of Fracture Of Orbit Except Blo Wout With |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21406. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21406 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 21406) and we'll show you how you compare in 15 minutes or less.