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South Dakota 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
$138.02 / $138.02 / $156.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.52 / $109.61 / $156.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.50 / $163.50 / $204.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.88 / $177.31 / $743.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.10 / $140.93 / $241.49
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.40 / $225.39 / $259.92
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.43 / $225.39 / $408.70
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.59 / $377.27 / $430.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.77 / $82.10 / $187.91
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.59 / $156.59 / $156.59