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New Mexico 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
$630.49 / $1,260.98 / $2,521.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.49 / $1,008.78 / $1,008.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$546.41 / $546.41 / $546.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$966.01 / $966.01 / $1,207.51
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$546.41 / $546.41 / $840.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.33 / $840.65 / $840.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$504.39 / $756.59 / $1,260.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.07 / $353.07 / $504.39