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New Hampshire 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
$66.07 / $95.50 / $165.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $21.88 / $117.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $50.12 / $151.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $16.98 / $24.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $97.72 / $181.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $38.02 / $316.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $26.30 / $50.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $21.88 / $69.18