go back

California 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
$30.44 / $128.65 / $292.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.32 / $30.44 / $167.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.94 / $62.88 / $293.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.87 / $22.99 / $76.23
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.40 / $91.40 / $328.87
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.16 / $23.08 / $85.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.14 / $44.75 / $90.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $28.00 / $128.56
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.17 / $26.65 / $35.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.46 / $29.98 / $57.35
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.36 / $324.13 / $324.13
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$810.43 / $810.43 / $810.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.28 / $31.28 / $31.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.41 / $40.27 / $86.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.17 / $31.54 / $86.73
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.50 / $91.50 / $91.50
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.86 / $25.95 / $39.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.95 / $15.64 / $67.08