go back

Maine 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
$118.24 / $118.24 / $118.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.80 / $116.02 / $134.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.99 / $134.54 / $194.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.02 / $172.19 / $262.41
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.07 / $137.19 / $231.93
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.29 / $115.16 / $134.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.27 / $165.04 / $213.61