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Ohio 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 / $1,412.54 / $1,995.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $691.83 / $1,047.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $891.25 / $1,348.96
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $977.24 / $977.24
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $13,182.57 / $23,442.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $954.99 / $1,202.26
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $870.96 / $1,778.28
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $891.25 / $1,659.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $549.54 / $831.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $831.76