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Montana rates for HCPCS 87389

Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.65 / $90.75 / $166.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.78 / $24.08 / $47.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.27 / $32.27 / $68,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.27 / $32.27 / $32.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.11 / $71.16 / $137.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.50 / $27.67 / $34.59
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.11 / $71.16 / $137.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.67 / $21.67 / $30.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.11 / $10.11 / $24.08