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Ohio 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
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $7,585.78 / $13,803.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $3,548.13 / $15,135.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,379.62 / $21,379.62 / $21,379.62
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $3,981.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $9,332.54 / $13,803.84