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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
$29.98 / $95.15 / $182.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.32 / $24.84 / $29.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.89 / $50.47 / $129.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.43 / $16.94 / $16.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.24 / $114.40 / $181.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.52 / $51.18 / $315.12
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.07 / $37.84 / $92.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.95 / $15.64 / $35.76
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.78 / $30.90 / $45.04