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Utah 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
$1,659.59 / $3,388.44 / $12,882.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $309.03 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $190.55 / $263.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $60.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $234.42 / $316.23
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $165.96 / $194.98
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $213.80 / $245.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $194.98 / $346.74