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Wisconsin 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)

Facilitymedian $71 · 10th–90th $29–$1660%20%10th90th$71Professionalmedian $25 · 10th–90th $13–$1000%5%10%10th90th$25$5.0$10.0$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $57.54 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.20 / $23.99 / $39.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $70.79 / $72.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $107.15
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $85.11 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.05 / $39.81 / $81.28
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $144.54 / $223.87
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $173.78
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$23.44 / $35.48 / $141.25
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $21.88 / $812.83
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.30 / $53.70 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $31.62 / $74.13
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.30 / $44.67 / $74.13
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $66.07 / $91.20
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $323.59 / $323.59
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $724.44 / $812.83
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $100.00
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $104.71 / $162.18
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.33 / $23.44 / $63.10
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $20.89 / $39.81