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Utah 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
$1,862.09 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $223.87 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $190.55
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
$213.80 / $275.42 / $416.87
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $269.15 / $281.84
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $263.03 / $309.03
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
$144.54 / $218.78 / $467.74