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Vermont 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
$141.88 / $141.88 / $141.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.53 / $191.53 / $191.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.75 / $131.75 / $164.68
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.53 / $191.53 / $191.53
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.38 / $131.75 / $164.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.66 / $68.66 / $160.19