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New Hampshire rates for HCPCS G0481

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;8-14 Drug Class(Es) Including Metabolites(S)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.62 / $363.00 / $2,162.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.09 / $99.62 / $102.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.58 / $303.13 / $707.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.64 / $101.78 / $120.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$289.67 / $654.67 / $675.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.04 / $82.33 / $204.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.52 / $278.29 / $704.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.77 / $93.95 / $93.95
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.84 / $110.21 / $162.01