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Washington 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

Facilitymedian $1,000 · 10th–90th $832–$4,6770%20%40%10th90th$1,000Professionalmedian $759 · 10th–90th $562–$8320%20%10th90th$759$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $3,801.89 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $691.83 / $812.83
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $1,230.27 / $1,698.24
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $758.58 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $1,862.09 / $2,187.76
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $954.99 / $1,202.26
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $50.12 / $64.57
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $831.76 / $1,000.00
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $1,348.96 / $2,630.27
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $1,047.13
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $1,258.93 / $1,949.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $758.58 / $831.76
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $1,000.00 / $1,000.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $354.81 / $831.76
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $436.52 / $1,513.56