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Louisiana 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
$891.09 / $1,213.06 / $4,421.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.49 / $933.12 / $1,092.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$910.26 / $1,641.71 / $2,586.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.93 / $238.70 / $291.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$879.59 / $1,612.56 / $5,937.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.54 / $966.01 / $1,207.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.63 / $504.39 / $840.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.26 / $420.33 / $1,260.98