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California 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
$1,174.90 / $3,467.37 / $5,754.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $691.83 / $831.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $4,168.69 / $4,265.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $870.96 / $1,412.54
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $660.69 / $1,949.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $1,412.54 / $2,818.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,023.29 / $1,288.25
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $831.76 / $1,348.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $831.76 / $1,479.11
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $3,981.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $19.95
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $977.24 / $2,137.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $831.76 / $831.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $457.09 / $831.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $380.19 / $1,513.56