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Arizona rates for HCPCS 0322U

Neurology (autism spectrum disorder [ASD]), quantitative measurements of 14 acyl carnitines and microbiome-derived metabolites, liquid chromatography with tandem mass spectrometry (LC-MS/MS), plasma, results reported as negative or positive for risk of metabolic subtypes associated with ASD

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$683.40 / $1,147.50 / $2,992.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.50 / $502.50 / $502.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$475.29 / $1,869.66 / $3,109.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.11 / $715.80 / $1,020.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$435.62 / $1,170.00 / $2,096.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.93 / $913.97 / $1,142.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $562.50 / $3,562.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $315.00 / $600.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $315.00 / $450.00