go back

Mississippi 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
$840.65 / $1,538.39 / $1,706.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$664.11 / $924.72 / $1,614.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.25 / $32.25 / $32.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.25 / $32.25 / $32.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$546.41 / $546.41 / $573.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$966.01 / $966.01 / $1,207.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $20.00 / $20.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$756.59 / $756.59 / $840.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.07 / $420.33 / $1,260.98