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Montana rates for HCPCS 0328U

Drug assay, definitive, 120 or more drugs and metabolites, urine, quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS), includes specimen validity and algorithmic analysis describing drug or metabolite and presence or absence of risks for a significant patient-adverse event, per date of service

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,008.29 / $6,008.29 / $6,008.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.92 / $165.92 / $165.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.75 / $164.68 / $165.92
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.92 / $165.92 / $165.92
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.43 / $137.32 / $165.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.06 / $48.06 / $114.43