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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
$798.62 / $798.62 / $1,245.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.33 / $798.62 / $798.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$560.03 / $560.03 / $589.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.03 / $589.51 / $795.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.65 / $1,024.65 / $1,280.81
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$798.62 / $798.62 / $1,467.46
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.62 / $807.02 / $1,008.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.65 / $840.65 / $1,008.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.07 / $504.39 / $840.65