go back

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
$676.08 / $2,630.27 / $2,818.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $676.08 / $812.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,778.28 / $2,691.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $758.58 / $758.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $1,318.26 / $2,187.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,023.29 / $1,288.25
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $676.08 / $831.76
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $630.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $831.76 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $416.87 / $831.76
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $3,981.07