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Washington 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
$794.33 / $3,801.89 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $676.08 / $1,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,862.09 / $2,187.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $1,202.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $50.12 / $64.57
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $933.25 / $1,479.11
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,479.11 / $2,511.89
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,000.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,258.93 / $2,238.72
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $758.58 / $831.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,000.00 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $831.76
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $380.19 / $1,513.56