Percutaneous Skeletal Fixation Of Posterior Pelvic Bone Fracture And/or Dislocation, For Fracture Patterns Which Disrupt The Pelvic Ring, Unilateral Or Bilateral, (includes Ilium, Sacroiliac Joint And/or Sacrum)

Medicare Payment (avg)
$660.28
What Medicare actually pays
Billed Charge (avg)
$3,651.34
What providers submit
Markup
5.5x
453% above Medicare rate
1.7K
Total Services
1.4K
Beneficiaries
777
Providers
36
States with Data

Price Range Across States

Lowest State Avg
$448.06
Kansas
Highest State Avg
$829.46
Massachusetts

What You Might Pay

Est. Commercial Insurance
$1,855.75
Range: $1,299.03 – $2,598.06
Est. Cash / Self-Pay
$1,625.47
Typical self-pay discount

Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.

How we estimate these prices

These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Temporary Procedures procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.

Prices by State

State Medicare Payment Billed Charge
Massachusetts $829.46 $5,308.38
Michigan $795.18 $2,654.97
Georgia $791.55 $2,897.11
New York $772.31 $5,300.31
Maryland $763.20 $4,062.78
Connecticut $750.91 $5,861.25
Texas $737.99 $3,240.57
Wisconsin $719.98 $5,883.85
Colorado $719.33 $2,257.08
Kentucky $712.63 $3,457.43
Missouri $702.04 $3,622.74
Ohio $699.67 $3,605.41
Minnesota $695.35 $4,475.97
California $685.49 $3,707.48
Florida $678.36 $3,680.17
Illinois $673.05 $4,372.36
North Carolina $672.23 $3,037.38
New Hampshire $670.69 $6,283.34
Alabama $669.84 $3,761.72
Tennessee $659.45 $3,298.35
Louisiana $657.78 $2,901.84
Pennsylvania $654.79 $3,196.57
Utah $653.56 $2,131.95
South Carolina $651.03 $3,250.79
Arizona $643.71 $3,173.12
Virginia $631.50 $2,934.32
Oklahoma $620.34 $2,427.30
Arkansas $611.83 $2,054.65
Mississippi $610.95 $3,507.05
Washington $608.38 $2,680.08
New Jersey $574.96 $9,582.22
Indiana $570.49 $2,717.74
Nevada $531.11 $3,607.54
Idaho $504.50 $2,721.14
Delaware $448.34 $5,367.89
Kansas $448.06 $2,277.18

What the Data Says About Percutaneous Skeletal Fixation Of Posterior Pelvic Bone Fracture And/or Dislocation, For Fracture Patterns Which Disrupt The Pelvic Ring, Unilateral Or Bilateral, (includes Ilium, Sacroiliac Joint And/or Sacrum)

Across 36 states with reporting providers, CPT code G0413 (Percutaneous Skeletal Fixation Of Posterior Pelvic Bone Fracture And/or Dislocation, For Fracture Patterns Which Disrupt The Pelvic Ring, Unilateral Or Bilateral, (includes Ilium, Sacroiliac Joint And/or Sacrum)) shows a national average Medicare payment of $660.28 against an average billed charge of $3,651.34. That gap — a 5.5x markup, or 453% above the Medicare allowed amount — reflects chargemaster pricing, not what most insured patients actually pay. Medicare's negotiated rate is the statutory benchmark; commercial insurers typically settle between the two figures based on network contracts.

Temporary Procedures procedures like this one saw 1.7K services billed to Medicare in 2023 by 777 distinct providers, serving 1.4K unique beneficiaries. State-level variation is significant: Kansas reports the lowest average payment at $448.06, while Massachusetts reports the highest at $829.46. Geographic Practice Cost Indices (GPCIs) explain much of that spread — local malpractice premiums, practice expense, and physician work adjustments all shift the allowed amount even when the procedure is identical.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Temporary Procedures category (2.24x), the estimated commercial insurance price lands near $1,855.75, with self-pay cash discounts commonly bringing the figure closer to $1,625.47. Uninsured patients facing the full billed charge have the strongest leverage to negotiate — the Hospital Price Transparency Rule (effective January 2021) requires providers to publish standard charges, cash rates, and payer-specific negotiated prices. This data is for educational reference; confirm coverage and out-of-pocket exposure with your insurer before any procedure.

Frequently Asked Questions

How much does Percutaneous Skeletal Fixation Of Posterior Pelvic Bone Fracture And/or Dislocation, For Fracture Patterns Which Disrupt The Pelvic Ring, Unilateral Or Bilateral, (includes Ilium, Sacroiliac Joint And/or Sacrum) cost?

The national average Medicare payment for Percutaneous Skeletal Fixation Of Posterior Pelvic Bone Fracture And/or Dislocation, For Fracture Patterns Which Disrupt The Pelvic Ring, Unilateral Or Bilateral, (includes Ilium, Sacroiliac Joint And/or Sacrum) (CPT G0413) is $660.28, while providers typically bill $3,651.34. Prices vary significantly by state, ranging from $448.06 to $829.46.

Why do providers charge more than Medicare pays?

Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.

How much does Percutaneous Skeletal Fixation Of Posterior Pelvic Bone Fracture And/or Dislocation, For Fracture Patterns Which Disrupt The Pelvic Ring, Unilateral Or Bilateral, (includes Ilium, Sacroiliac Joint And/or Sacrum) cost with insurance?

With commercial insurance, Percutaneous Skeletal Fixation Of Posterior Pelvic Bone Fracture And/or Dislocation, For Fracture Patterns Which Disrupt The Pelvic Ring, Unilateral Or Bilateral, (includes Ilium, Sacroiliac Joint And/or Sacrum) costs an estimated $1,855.75 on average (range: $1,299.03 – $2,598.06). Without insurance, the estimated cash price is $1,625.47. These estimates are based on RAND 2024 research on commercial-to-Medicare price ratios. Your actual cost depends on your insurer, plan, and provider.

Which state has the lowest cost for Percutaneous Skeletal Fixation Of Posterior Pelvic Bone Fracture And/or Dislocation, For Fracture Patterns Which Disrupt The Pelvic Ring, Unilateral Or Bilateral, (includes Ilium, Sacroiliac Joint And/or Sacrum)?

Kansas has the lowest average Medicare payment for Percutaneous Skeletal Fixation Of Posterior Pelvic Bone Fracture And/or Dislocation, For Fracture Patterns Which Disrupt The Pelvic Ring, Unilateral Or Bilateral, (includes Ilium, Sacroiliac Joint And/or Sacrum) at $448.06, while Massachusetts has the highest at $829.46. This $381.40 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.

How many providers perform Percutaneous Skeletal Fixation Of Posterior Pelvic Bone Fracture And/or Dislocation, For Fracture Patterns Which Disrupt The Pelvic Ring, Unilateral Or Bilateral, (includes Ilium, Sacroiliac Joint And/or Sacrum)?

Nationally, 777 providers billed Medicare for Percutaneous Skeletal Fixation Of Posterior Pelvic Bone Fracture And/or Dislocation, For Fracture Patterns Which Disrupt The Pelvic Ring, Unilateral Or Bilateral, (includes Ilium, Sacroiliac Joint And/or Sacrum) in 2023, performing 1.7K total services for 1.4K beneficiaries across 36 states and territories.

What is the billed-to-Medicare markup for Percutaneous Skeletal Fixation Of Posterior Pelvic Bone Fracture And/or Dislocation, For Fracture Patterns Which Disrupt The Pelvic Ring, Unilateral Or Bilateral, (includes Ilium, Sacroiliac Joint And/or Sacrum)?

Providers bill 5.5x what Medicare pays for Percutaneous Skeletal Fixation Of Posterior Pelvic Bone Fracture And/or Dislocation, For Fracture Patterns Which Disrupt The Pelvic Ring, Unilateral Or Bilateral, (includes Ilium, Sacroiliac Joint And/or Sacrum) — a 453% markup. This gap between billed charges and actual payment is common across healthcare. Uninsured patients may face charges closer to the billed amount, while insured patients pay negotiated rates between the Medicare and billed figures.

Related

Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure Editorial