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Louisiana 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
$133.08 / $133.08 / $160.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.75 / $133.08 / $178.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.34 / $128.21 / $203.80
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $104.66 / $104.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.52 / $127.87 / $201.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.22 / $122.01 / $210.70