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Tennessee 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 / $1,166.41 / $2,362.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.49 / $664.11 / $748.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$437.14 / $630.49 / $1,345.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$557.35 / $1,668.60 / $2,404.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$966.01 / $1,024.65 / $1,280.81
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,462.73 / $3,993.09 / $3,993.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.63 / $504.39 / $840.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.07 / $504.39 / $840.65