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Missouri 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
$812.83 / $1,412.54 / $1,621.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $707.95 / $1,047.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $616.60 / $1,348.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,621.81 / $1,995.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $977.24 / $1,202.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,479.11 / $3,981.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $831.76 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $1,000.00