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Utah 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
$756.59 / $3,964.53 / $5,197.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.83 / $664.11 / $966.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$718.54 / $739.02 / $2,316.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$966.01 / $966.01 / $1,207.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $45.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.65 / $966.75 / $1,008.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$643.47 / $657.61 / $714.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.07 / $353.07 / $504.39