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Oklahoma 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
$630.49 / $840.65 / $2,017.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.08 / $622.08 / $630.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.62 / $798.62 / $840.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$546.41 / $552.53 / $1,087.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$966.01 / $966.01 / $1,207.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$504.39 / $680.93 / $2,816.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.07 / $353.07 / $840.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.63 / $756.59 / $840.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.07 / $353.07 / $840.65