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Montana 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
Professional
Modifier
Low / Median / High Price
$966.75 / $966.75 / $966.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,218.94 / $1,218.94 / $1,218.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$966.01 / $1,207.51 / $1,218.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,218.94 / $1,218.94 / $1,218.94
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$756.59 / $840.65 / $1,050.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.07 / $353.07 / $840.65