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Pennsylvania 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
$203.57 / $344.98 / $596.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.45 / $104.54 / $135.22
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.30 / $93.95 / $93.95
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$424.80 / $551.62 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.14 / $122.14 / $122.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.92 / $181.60 / $407.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.33 / $82.33 / $163.50
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.03 / $92.39 / $212.02
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.00 / $229.69 / $489.90
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.23 / $112.50 / $133.11
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.10 / $343.97 / $646.72
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.59 / $109.61 / $171.30
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.89 / $242.71 / $337.65
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.54 / $188.29 / $454.90
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.33 / $82.33 / $163.50
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.29 / $156.59 / $156.59
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.29 / $156.59 / $156.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.64 / $93.95 / $243.09