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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
$1,258.93 / $2,754.23 / $2,754.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $676.08 / $1,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $1,202.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $794.33 / $1,000.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $501.19