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
1417M RL-A-HIVPHENOGT 92399
Henderson, NV
See all hospitals reporting CPT 87904 →Price type
Dignity Health’s median price of $55 is 83% above the median hospital's median price ($30), higher than 78% of the 1,733 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: 6 payers, 18 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 | Anthem commercial|hmo fee schedule · outpatient | $17 | $17 | — | — | — | $17 – $17 |
| 2 | Anthem commercial|ppo fee schedule · outpatient | $17 | $17 | — | — | — | $17 – $17 |
| 3 | Aetna medicare|all plans fee schedule · outpatient | $26 | $26 | — | — | — | $26 – $26 |
| 4 | Anthem medicare|all plans fee schedule · outpatient | $26 | $26 | — | — | — | $26 – $26 |
| 5 | Humana medicare|all plans fee schedule · outpatient | $26 | $26 | — | — | — | $26 – $26 |
| 6 | UnitedHealthcare medicare|all plans fee schedule · outpatient | $27 | $27 | — | — | — | $27 – $27 |
| 7 | UnitedHealthcare commercial|all payer fee schedule · outpatient | $39 | $39 | — | — | — | $39 – $39 |
| 8 | Aetna commercial|hmo fee schedule · outpatient | $54 | $54 | — | — | — | $54 – $54 |
| 9 | Aetna commercial|all other plans fee schedule · outpatient | $55 | $55 | — | — | — | $55 – $55 |
| 10 | Aetna commercial|ppo fee schedule · outpatient | $55 | $55 | — | — | — | $55 – $55 |
| 11 | UnitedHealthcare commercial|dh employees fee schedule · inpatient | $68 | $68 | — | — | — | $68 – $68 |
| 12 | UnitedHealthcare commercial|dh employees fee schedule · outpatient | $68 | $68 | — | — | — | $68 – $68 |
| 13 | Cigna commercial|all other plans fee schedule · outpatient | $95 | $95 | — | — | — | $95 – $95 |
| 14 | Cigna commercial|ppo fee schedule · outpatient | $95 | $95 | — | — | — | $95 – $95 |
| 15 | MultiPlan commercial|all plans fee schedule · inpatient | $156 | $156 | — | — | — | $156 – $156 |
| 16 | MultiPlan commercial|all plans fee schedule · outpatient | $156 | $156 | — | — | — | $156 – $156 |
| 17 | UnitedHealthcare commercial|options fee schedule · inpatient | $163 | $163 | — | — | — | $163 – $163 |
| 18 | UnitedHealthcare commercial|options fee schedule · outpatient | $163 | $163 | — | — | — | $163 – $163 |
Last updated: Feb 28, 2026
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