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Kansas 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
$925.18 / $1,737.12 / $2,684.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.49 / $731.37 / $899.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,050.81 / $1,050.81 / $1,050.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$552.53 / $885.20 / $1,906.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$966.01 / $975.67 / $1,226.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$504.39 / $689.33 / $1,462.73
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.07 / $504.39 / $1,429.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.63 / $840.65 / $1,260.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.07 / $504.39 / $1,429.11