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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.94 / $129.94 / $129.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.87 / $114.68 / $129.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.36 / $155.01 / $232.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.44 / $93.51 / $114.31
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.02 / $177.12 / $241.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.20 / $129.60 / $192.29