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California rates for HCPCS 0054U

Prescription drug monitoring, 14 or more classes of drugs and substances, definitive tandem mass spectrometry with chromatography, capillary blood, quantitative report with therapeutic and toxic ranges, including steady-state range for the prescribed dose when detected, per date of service

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.14 / $432.47 / $1,188.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.21 / $137.38 / $140.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.36 / $448.08 / $840.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.77 / $188.75 / $379.79
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.40 / $218.49 / $1,484.71
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.43 / $129.18 / $324.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.51 / $261.41 / $498.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.55 / $112.55 / $112.55
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.17 / $198.74 / $268.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.87 / $228.55 / $424.99
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$345.81 / $944.02 / $944.02
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$989.73 / $989.73 / $1,490.55
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.18 / $238.49 / $439.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.86 / $180.24 / $223.44
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.96 / $148.96 / $148.96
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.55 / $158.99 / $202.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.56 / $70.18 / $398.56