go back

Pennsylvania 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
$1,023.29 / $2,290.87 / $3,715.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $676.08 / $954.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $1,288.25 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $1,202.26
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $501.19 / $1,230.27
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $831.76 / $1,445.44
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $2,137.96 / $3,548.13
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $707.95 / $3,019.95
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $831.76 / $933.25
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $741.31 / $933.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $831.76 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $1,258.93