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Georgia 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
$562.34 / $758.58 / $2,344.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $660.69 / $812.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,071.52 / $1,778.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $831.76 / $851.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,862.09 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,023.29 / $1,288.25
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $977.24 / $1,096.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $758.58 / $831.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $1,230.27