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Indiana 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
$26.30 / $40.74 / $95.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $21.38 / $26.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.30 / $26.30 / $77.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $26.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $26.30 / $58.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $56.23 / $91.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.30 / $26.30 / $31.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $15.49 / $28.84