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Pennsylvania 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
$93.01 / $232.60 / $581.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.63 / $74.38 / $96.20
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.22 / $68.66 / $114.43
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.72 / $104.26 / $1,578.47
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$276.10 / $358.54 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.26 / $89.26 / $89.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.20 / $148.66 / $334.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.16 / $60.16 / $119.63
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.15 / $67.51 / $154.94
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.25 / $237.60 / $521.60
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.66 / $80.31 / $90.75
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.60 / $99.87 / $211.11
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.09 / $244.88 / $581.33
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.88 / $80.09 / $114.43
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.38 / $148.76 / $379.22
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.16 / $60.16 / $119.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.93 / $114.43 / $114.43
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.93 / $114.43 / $114.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.95 / $68.66 / $171.65