go back

Michigan 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 / $794.33 / $1,479.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $707.95 / $1,000.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $588.84 / $588.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $588.84 / $588.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,023.29 / $1,288.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $1,995.26
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $831.76 / $1,122.02
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $1,023.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $831.76 / $831.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $537.03