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Colorado 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
$851.14 / $2,951.21 / $4,677.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $676.08 / $812.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $2,454.71 / $4,073.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $549.54 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $954.99 / $1,202.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $1,202.26
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $380.19 / $380.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $616.60