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Maine 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
$840.65 / $840.65 / $1,786.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$680.93 / $680.93 / $680.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.26 / $336.26 / $546.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$966.01 / $966.01 / $1,207.51
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.65 / $840.65 / $1,018.03
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.65 / $840.65 / $1,361.85
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$680.93 / $680.93 / $840.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.39 / $504.39 / $1,471.14