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Utah rates for HCPCS G0481

Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed

Facilitymedian $170 · 10th–90th $48–$5890%10%10th90th$170Professionalmedian $110 · 10th–90th $85–$1480%10%20%10th90th$110$10.0$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $169.82 / $588.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $109.65 / $147.91
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $162.18 / $426.58
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $204.17
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $218.78
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $630.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $131.83 / $141.25
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $154.88 / $489.78
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $138.04 / $154.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $66.07 / $123.03