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Arizona 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
$645.65 / $1,698.24 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $630.96 / $812.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $1,737.80 / $2,570.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $794.33 / $1,584.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $645.65 / $2,344.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,023.29 / $1,288.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $691.83 / $3,981.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $831.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $831.76 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $676.08