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Virginia 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
$101.38 / $122.61 / $281.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.30 / $108.70 / $136.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.90 / $123.36 / $188.21
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.58 / $123.58 / $252.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.48 / $151.80 / $246.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.85 / $118.40 / $146.59
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.38 / $134.29 / $208.05
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.00 / $161.21 / $219.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.92 / $152.75 / $256.04
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.92 / $152.75 / $256.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.77 / $153.12 / $227.41