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Alaska rates for HCPCS 0117U

Pain management, analysis of 11 endogenous analytes (methylmalonic acid, xanthurenic acid, homocysteine, pyroglutamic acid, vanilmandelate, 5-hydroxyindoleacetic acid, hydroxymethylglutarate, ethylmalonate, 3-hydroxypropyl mercapturic acid (3-HPMA), quinolinic acid, kynurenic acid), LC-MS/MS, urine, algorithm reported as a pain-index score with likelihood of atypical biochemical function associated with pain

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $6,606.93 / $10,232.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $794.33 / $2,818.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,344.23 / $2,344.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $1,202.26
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $831.76 / $3,801.89
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $831.76 / $2,691.53
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $3,090.30 / $3,388.44
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,905.46 / $1,905.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $660.69 / $1,548.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $831.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $1,698.24 / $2,511.89