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New Jersey 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
$1,071.52 / $1,122.02 / $5,011.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $676.08 / $1,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,862.09 / $3,890.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,023.29 / $1,288.25
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $398.11 / $501.19
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $10,471.29 / $26,302.68
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $549.54 / $676.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $831.76 / $1,737.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $501.19 / $870.96