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Montana 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
Professional
Modifier
Low / Median / High Price
$1,278.96 / $1,278.96 / $1,278.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,087.50 / $1,087.50 / $1,087.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.93 / $1,077.41 / $1,087.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,087.50 / $1,087.50 / $1,087.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.00 / $900.00 / $1,087.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $315.00 / $750.00