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Idaho 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
$1,513.56 / $1,513.56 / $2,187.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $794.33 / $1,621.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,584.89 / $3,019.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $831.76 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $1,737.80 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $954.99 / $1,202.26
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $1,621.81
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $891.25 / $1,000.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,621.81 / $3,019.95
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $891.25
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $1,000.00