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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
$18.20 / $97.72 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $19.95 / $39.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $22.91 / $72.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $31.62 / $50.12
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.30 / $58.88 / $138.04
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $22.39 / $25.70
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $18.20 / $26.30
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $22.91 / $38.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $15.49 / $15.85