go back

Utah 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
$18.28 / $95.79 / $125.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.28 / $18.28 / $18.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.29 / $22.92 / $71.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.36 / $31.00 / $49.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.07 / $29.98 / $117.33
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.48 / $25.77 / $31.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.95 / $15.51 / $15.99