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Montana rates for HCPCS G0480

Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.20 / $268.39 / $402.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.63 / $74.38 / $95.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.34 / $153.34 / $77,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.34 / $153.34 / $153.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.92 / $234.58 / $341.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.63 / $149.53 / $165.92
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.92 / $234.58 / $341.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.99 / $102.99 / $165.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.57 / $48.06 / $114.43