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South Dakota 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
$116.02 / $116.02 / $116.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.70 / $105.98 / $142.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.34 / $218.06 / $268.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.34 / $172.23 / $277.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.82 / $223.67 / $686.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.08 / $251.40 / $276.45
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.26 / $225.71 / $276.45
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.05 / $174.32 / $205.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.82 / $201.38 / $243.51
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.50 / $258.80 / $258.80