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Idaho rates for HCPCS 96004

Review and interpretation by physician or other qualified health care professional of comprehensive computer-based motion analysis, dynamic plantar pressure measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography, with written report

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.70 / $116.46 / $151.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.74 / $180.85 / $215.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.88 / $156.77 / $194.21
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.19 / $179.45 / $205.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $150.60 / $189.46
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $158.69 / $191.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.72 / $162.00 / $220.32