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Massachusetts 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
$588.84 / $1,905.46 / $2,630.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $630.96 / $812.83
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $3,981.07
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $1,258.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $616.60 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,023.29 / $1,288.25
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $1,412.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $831.76 / $1,862.09
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $3,981.07
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $1,258.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $831.76 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $645.65 / $1,905.46