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South Dakota 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
$1,314.20 / $1,314.20 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,628.96 / $2,162.35 / $3,557.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,700.74 / $2,121.59 / $3,123.82
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.97 / $2,298.17 / $2,694.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00