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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)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.98 / $167.63 / $167.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.79 / $44.32 / $148.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.86 / $37.79 / $37.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.79 / $44.32 / $148.60
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.46 / $23.46 / $37.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.95 / $10.95 / $26.07