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Illinois 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
$870.96 / $1,445.44 / $2,511.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $707.95 / $954.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,122.02 / $1,380.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $1,584.89 / $3,890.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,023.29 / $1,288.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $1,096.48 / $1,513.56
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $831.76 / $1,698.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $831.76