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North Carolina 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
$672.52 / $672.52 / $1,395.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.46 / $672.52 / $672.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$638.76 / $1,560.13 / $2,207.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$966.01 / $966.01 / $1,207.51
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$504.39 / $672.52 / $840.65
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.41 / $840.65 / $840.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$504.39 / $991.97 / $1,008.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.29 / $420.33 / $840.65
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,462.73 / $3,993.09 / $3,993.09