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Pennsylvania 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
$24.55 / $70.79 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $21.88 / $77.62
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $181.97 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $20.42 / $58.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.99 / $42.66 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $25.12 / $60.26
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $33.88 / $48.98
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.30 / $26.30 / $26.30
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $39.81 / $83.18
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.55 / $69.18 / $117.49
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $23.99 / $107.15
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $45.71 / $45.71
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.99 / $23.99 / $26.30
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $25.70 / $26.30
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 / $38.02