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Utah 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
$90.39 / $217.62 / $713.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.59 / $108.05 / $133.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.84 / $163.56 / $431.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.33 / $163.50 / $204.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.25 / $219.23 / $219.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.59 / $180.08 / $634.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.86 / $122.41 / $133.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.66 / $65.77 / $93.95