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Tennessee 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
$1,392.60 / $3,939.75 / $7,602.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,157.00 / $7,178.00 / $13,961.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,372.33 / $7,423.00 / $7,423.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,964.00 / $8,273.00 / $12,407.00