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Nebraska 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
$1,698.24 / $2,238.72 / $4,168.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $630.96 / $831.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,148.15 / $2,238.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,288.25 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,621.81 / $1,995.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $1,000.00 / $3,981.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $933.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $758.58 / $1,258.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $501.19 / $933.25