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Indiana 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
Facility
Modifier
Low / Median / High Price
$107.15 / $107.15 / $107.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $109.65 / $141.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $134.90 / $257.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $134.90 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $138.04 / $239.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $120.23 / $199.53