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New Hampshire 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
$2,137.96 / $2,137.96 / $5,888.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $588.84 / $676.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,621.81 / $4,786.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $1,621.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $2,630.27 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $1,202.26
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,479.11 / $2,691.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $1,288.25