go back

Minnesota 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 / $794.33 / $794.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $676.08 / $1,000.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $831.76 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $3,235.94 / $7,762.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,230.27 / $1,621.81
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $2,884.03 / $6,025.60
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $1,621.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,288.25 / $3,981.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $1,778.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $831.76 / $1,862.09