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Washington 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
$140.41 / $189.33 / $311.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.92 / $114.68 / $189.33
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.77 / $479.89 / $627.41
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.48 / $218.52 / $894.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.16 / $193.62 / $317.92
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.69 / $157.44 / $266.83
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.58 / $152.08 / $262.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.08 / $156.88 / $274.13
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.34 / $207.75 / $222.36
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.78 / $145.78 / $146.77
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.03 / $240.20 / $289.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.69 / $207.51 / $282.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.19 / $210.03 / $315.89
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.51 / $103.13 / $110.95