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South 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
$588.46 / $655.71 / $3,986.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.71 / $655.71 / $731.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.65 / $882.68 / $1,149.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,527.79 / $2,437.03 / $4,793.20
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
$630.49 / $722.96 / $1,114.71
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.65 / $840.65 / $840.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$756.59 / $840.65 / $840.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.07 / $504.39 / $1,008.78