0055T

Musculoskeletal surgical navigational orthopedic operation using imaging guidance

Medicare pricing data for 956 providers across 39 states

🤖AI Overview

Prices vary significantly by location — from $84 in Indiana to $252 in Florida. Where you get this procedure matters more than almost any other factor. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Musculoskeletal surgical navigational orthopedic operation using imaging guidance (HCPCS code 0055T) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $188.03, but hospitals typically charge $896.09 — a 4.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$37.61

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $188.03, your out-of-pocket cost would be approximately $37.61. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$188.03
Average Hospital Charge
$896.09
Markup Ratio
4.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$896.09
Medicare Allowed$188.03
Medicare Payment$150.08

Hospitals charge 4.8x more than what Medicare allows for this procedure. Medicare actually pays $150.08 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Florida$252$2,618701,937+33.9%
Missouri$245$73013384+30.2%
Ohio$243$371112+29.4%
New Jersey$236$1,2889178+25.5%
Louisiana$230$902351,307+22.3%
Colorado$228$3448125+21.3%
Michigan$223$49821322+18.8%
Texas$216$7701232,546+15.1%
Oklahoma$216$46111658+15.0%
Washington$213$62445558+13.2%
New Mexico$212$5656158+12.6%
Oregon$207$55611202+9.9%
Arizona$206$1,289391,283+9.5%
California$202$693592,145+7.7%
Mississippi$201$43413215+6.7%
Kansas$192$51822964+2.1%
New York$177$1,30145973-5.6%
Connecticut$177$51213193-5.9%
Utah$175$876567-6.7%
Illinois$173$964441,789-7.8%
Massachusetts$165$73119735-12.1%
Pennsylvania$164$543611,573-12.6%
Rhode Island$161$8812104-14.2%
New Hampshire$160$1,093331-14.7%
Idaho$153$5011054-18.4%
Iowa$150$5308154-20.0%
Vermont$148$7713131-21.1%
Georgia$147$76023296-21.9%
Maine$146$293112-22.5%
Virginia$143$72423224-24.2%
South Carolina$137$51816783-27.4%
Alabama$136$43714126-27.8%
North Carolina$135$353481,210-28.2%
Wisconsin$133$6839115-29.4%
Tennessee$128$544401,112-32.1%
West Virginia$120$88810196-36.3%
Minnesota$116$1,36426433-38.1%
Arkansas$112$2959231-40.3%
Indiana$84$42722181-55.1%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

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