Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
PHENOTYPE DNA HIV W/CLT ADD
Austin, TX
See all hospitals reporting CPT 87904 →Price type
Ascension Seton’s median price of $27 is 9% below the median hospital's median price ($30), higher than 33% of the 1,723 hospitals reporting CPT 87904. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 7 payers, 51 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Ambetter 3880_superior ambetter (chi,dcn) outpatient 20240901 fee schedule · outpatient | $22 | $22 | — | — | — | $22 – $22 |
| 2 | Blue Cross Blue Shield 4168_blue cross chip (chi,dcn) outpatient 20241201 fee schedule · outpatient | $22 | $22 | — | — | — | $22 – $22 |
| 3 | Blue Cross Blue Shield 4168_blue cross chip/star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $22 | $22 | — | — | — | $22 – $22 |
| 4 | Blue Cross Blue Shield 4169_blue cross chip (del) outpatient 20241201 fee schedule · outpatient | $22 | $22 | — | — | — | $22 – $22 |
| 5 | Blue Cross Blue Shield 4169_blue cross chip/star kids (del) outpatient 20241201 fee schedule · outpatient | $22 | $22 | — | — | — | $22 – $22 |
| 6 | Blue Cross Blue Shield 5003_blue cross star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $22 | $22 | — | — | — | $22 – $22 |
| 7 | Blue Cross Blue Shield 5005_blue cross star kids (del) outpatient 20241201 fee schedule · outpatient | $22 | $22 | — | — | — | $22 – $22 |
| 8 | UnitedHealthcare 4253_chirp uhc star (chi,dcn) outpatient 20241201 fee schedule · outpatient | $22 | $22 | — | — | — | $22 – $22 |
| 9 | UnitedHealthcare 4264_chirp uhc star plus (chi,dcn) outpatient 20241201 fee schedule · outpatient | $22 | $22 | — | — | — | $22 – $22 |
| 10 | UnitedHealthcare 4311_uhc star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $22 | $22 | — | — | — | $22 – $22 |
| 11 | Superior Healthplan 3509_chirp superior star (chi,dcn) inpatient 20240901 fee schedule · both | $24 | $23 | $2 | 7% | — | $21 – $24 |
| 12 | Superior Healthplan 4188_superior star foster outpatient 20241201 fee schedule · outpatient | $24 | $23 | $2 | 7% | — | $21 – $24 |
| 13 | Superior Healthplan 4189_superior star foster (chi,dcn) outpatient 20241201 fee schedule · outpatient | $24 | $23 | $2 | 7% | — | $21 – $24 |
| 14 | Superior Healthplan 4241_chirp superior star (chi,dcn) outpatient 20241201 fee schedule · outpatient | $24 | $23 | $2 | 7% | — | $21 – $24 |
| 15 | Superior Healthplan 4242_chirp superior star (del) outpatient 20241201 fee schedule · outpatient | $24 | $23 | $2 | 7% | — | $21 – $24 |
| 16 | Superior Healthplan 4375_chirp superior star plus (chi,dcn) inpatient 20240901 fee schedule · both | $24 | $23 | $2 | 7% | — | $21 – $24 |
| 17 | Superior Healthplan 4389_chirp superior star plus (chi,dcn) outpatient 20241201 fee schedule · outpatient | $24 | $23 | $2 | 7% | — | $21 – $24 |
| 18 | Superior Healthplan 4391_chirp superior star plus (del) outpatient 20241201 fee schedule · outpatient | $24 | $23 | $2 | 7% | — | $21 – $24 |
| 19 | Superior Healthplan 4888_superior star kids outpatient 20241201 fee schedule · outpatient | $24 | $23 | $2 | 7% | — | $21 – $24 |
| 20 | Superior Healthplan 4889_superior star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $24 | $23 | $2 | 7% | — | $21 – $24 |
| 21 | Blue Cross Blue Shield 4219_chirp blue cross star (chi,dcn) outpatient 20241201 fee schedule · both | $27 | $27 | — | — | — | $27 – $27 |
| 22 | Blue Cross Blue Shield 4220_chirp blue cross star (del) outpatient 20241201 fee schedule · both | $27 | $27 | — | — | — | $27 – $27 |
| 23 | UnitedHealthcare 4254_chirp uhc star (del) outpatient 20241201 fee schedule · both | $27 | $27 | — | — | — | $27 – $27 |
| 24 | UnitedHealthcare 4265_chirp uhc star plus (del) outpatient 20241201 fee schedule · both | $27 | $27 | — | — | — | $27 – $27 |
| 25 | UnitedHealthcare 4312_uhc star kids (del) outpatient 20241201 fee schedule · both | $27 | $27 | — | — | — | $27 – $27 |
Last updated: Jan 1, 2026
See HIV-1 drug resistance testing, each additional drug pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.