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Washington 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
$1,114.90 / $13,147.68 / $23,856.49
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,423.00 / $36,627.79 / $70,860.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.97 / $765.00 / $870.49
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,302.69 / $2,644.61 / $3,761.65
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,963.50 / $2,643.15 / $2,759.06
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,841.90 / $1,841.90 / $1,881.93
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27,977.90 / $36,627.79 / $70,064.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.00 / $5,547.00 / $19,271.00