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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
$630.96 / $660.69 / $912.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $660.69 / $954.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $831.76 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $1,737.80 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,023.29 / $1,288.25
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $3,981.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $575.44 / $831.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $831.76