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Vermont 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
Professional
Modifier
Low / Median / High Price
$24.84 / $45.48 / $167.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$202.06 / $443.71 / $464.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.65 / $43.65 / $43.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.00 / $48.76 / $110.29
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.65 / $43.65 / $43.65
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.92 / $48.76 / $110.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.39 / $36.42 / $60.23