go back

Hawaii 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
$691.83 / $831.76 / $1,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $660.69 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,000.00 / $1,047.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,000.00 / $1,258.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $831.76 / $1,258.93