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Utah 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

Facilitymedian $129 · 10th–90th $129–$1290%50%100%$129Professionalmedian $115 · 10th–90th $100–$3630%10%20%10th90th$115$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $114.82 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $154.88 / $229.09
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $33.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $151.36 / $239.88
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $165.96 / $234.42
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $162.18 / $229.09
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $125.89 / $194.98