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Pennsylvania rates for HCPCS 0054T

Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image-guidance based on fluoroscopic images (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,691.53 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $169.82 / $467.74
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $331.13 / $537.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $281.84 / $281.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $190.55 / $794.33
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $281.84 / $331.13
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $398.11
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $2,344.23 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $169.82 / $575.44
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $263.03 / $263.03
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $229.09 / $263.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $676.08 / $4,265.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $331.13 / $575.44