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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
$54.95 / $151.36 / $295.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $25.12 / $173.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $60.26 / $131.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $38.02 / $77.62
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $95.50 / $354.81
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $28.84 / $75.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $45.71 / $109.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $24.55 / $81.28
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $26.92 / $35.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $28.84 / $45.71
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $323.59 / $323.59
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $31.62 / $31.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $36.31 / $85.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $28.84 / $74.13
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $91.20 / $91.20
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $25.70 / $39.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $26.30 / $26.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $15.49 / $56.23