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Montana rates for HCPCS G0415

Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when performed (includes ilium, sacroiliac joint and/or sacrum)

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,165.23 / $2,165.23 / $2,165.23
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,075.25 / $1,478.47 / $2,530.00