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Utah 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
$1,698.24 / $6,025.60 / $10,964.78
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,952.62 / $23,442.29 / $52,480.75
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,137.96 / $3,019.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $5,128.61 / $15,848.93