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Maine rates for HCPCS 87904

Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; each additional drug tested (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.07 / $26.07 / $65.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.12 / $21.12 / $26.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.23 / $38.32 / $272.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.43 / $10.43 / $33.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.62 / $55.62 / $59.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.29 / $26.52 / $41.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.07 / $26.07 / $26.33
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.07 / $26.07 / $65.18
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.12 / $26.07 / $26.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.64 / $21.31 / $62.14