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Wisconsin 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
$120.23 / $1,905.46 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $204.17 / $562.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,584.89 / $1,584.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $275.42 / $676.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $478.63 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $251.19 / $281.84
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $323.59 / $10,471.29
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $323.59 / $1,778.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $457.09 / $1,548.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $54.95 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $501.19 / $707.95
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $537.03 / $1,258.93
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $851.14 / $1,513.56
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,000.00 / $1,071.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,584.89 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $380.19 / $776.25