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New Hampshire rates for HCPCS G0480

Drug Test(S) Definitive Utilizing (1) Drug Identification Methods Able To Identify Individualdrugs And Distinguish Between Structural Isomers Including But Not Limited To Gc/Ms And Lc/Ms (2) Stable Isotope Or Other Universally Recognized Internal Standards In All Samples And (3) Method Or Drug-Specific Calibration And Matrix-Matched Quality Control Material; Qualitative Or Quantita-Tive Includes Specimen Validity Testing Per Day;1-7 Drug Class(Es) Including Metabolites(S)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.75 / $176.57 / $851.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.96 / $64.75 / $64.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.24 / $221.51 / $517.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.77 / $74.37 / $87.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.69 / $469.44 / $494.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.36 / $60.16 / $149.53
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.30 / $203.36 / $514.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.96 / $68.66 / $253.46
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.69 / $71.63 / $105.29