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Montana 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)

Facilitymedian $39 · 10th–90th $26–$810%10%20%10th90th$39Professionalmedian $25 · 10th–90th $15–$790%10%10th90th$25$10.0$20.0$50.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $23.99 / $173.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $44.67 / $147.91
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17.78 / $17.78 / $38.02
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.30 / $35.48 / $79.43
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.30 / $35.48 / $79.43
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $44.67 / $147.91
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $23.44 / $41.69
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.30 / $26.30 / $26.30
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $14.79 / $36.31