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Utah 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
$71.95 / $197.10 / $629.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.88 / $80.09 / $95.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.81 / $100.60 / $315.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.16 / $119.63 / $149.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.51 / $160.19 / $160.19
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.43 / $131.59 / $463.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.59 / $89.59 / $97.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.57 / $48.06 / $68.66