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Minnesota 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
$790.21 / $790.21 / $790.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.46 / $731.37 / $790.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$815.43 / $840.65 / $840.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$672.52 / $840.65 / $840.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,827.93 / $3,090.89 / $7,375.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.67 / $1,226.83 / $1,613.74
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,675.74 / $2,803.16 / $5,807.84
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$966.01 / $966.01 / $1,526.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.65 / $1,335.45 / $3,993.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.07 / $535.49 / $1,783.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.07 / $840.65 / $1,790.31