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Utah rates for HCPCS G0659

Drug test(s), definitive, utilizing 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), excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.83 / $376.39 / $493.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.98 / $52.82 / $71.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.11 / $54.63 / $171.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.68 / $64.88 / $81.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.56 / $100.56 / $100.56
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.14 / $71.45 / $261.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.57 / $48.70 / $52.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.10 / $33.52 / $37.28