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Indiana 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
$977.24 / $1,318.26 / $3,090.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $691.83 / $812.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $2,511.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $851.14 / $1,348.96
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $12,302.69 / $43,651.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,122.02 / $1,202.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $831.76 / $831.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $831.76