go back

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
$19.05 / $23.99 / $95.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $44.67 / $147.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $17.78 / $38.02
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.30 / $35.48 / $79.43
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $35.48 / $79.43
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.44 / $44.67 / $147.91
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $23.44 / $41.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $26.30