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Massachusetts 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
$111.58 / $111.58 / $111.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.87 / $111.58 / $151.63
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.80 / $333.85 / $519.17
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.19 / $201.81 / $686.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$261.19 / $311.43 / $386.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.14 / $198.65 / $283.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.97 / $210.73 / $381.50
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.38 / $165.66 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.37 / $117.50 / $193.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.84 / $246.31 / $326.81
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.80 / $245.80 / $519.17
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.52 / $214.42 / $686.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.93 / $160.27 / $329.53