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Pennsylvania rates for HCPCS 0055T

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $2,691.53 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $208.93 / $524.81
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
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
$363.08 / $426.58 / $426.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $354.81 / $354.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $190.55 / $1,000.00
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
$229.09 / $229.09 / $457.09
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,584.89 / $3,630.78
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $251.19 / $407.38
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $2,290.87 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $204.17 / $588.84
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $457.09
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $478.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $229.09 / $354.81
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $229.09 / $354.81
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
$186.21 / $436.52 / $776.25