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Idaho 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
$1,517.20 / $1,517.20 / $2,185.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.46 / $1,639.27 / $1,639.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$819.63 / $890.66 / $3,278.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.32 / $966.01 / $1,207.51
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$790.21 / $1,639.27 / $1,737.63
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.65 / $840.65 / $1,008.78
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,260.98 / $1,681.30 / $3,026.34
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$714.55 / $1,256.19 / $1,298.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.07 / $353.07 / $1,008.78