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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
$26.30 / $26.30 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $22.91 / $38.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $245.47 / $263.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $15.49 / $33.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $58.88 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $26.30 / $39.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $26.30 / $30.90
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.30 / $26.30 / $42.66
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $26.30 / $95.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $26.30 / $51.29