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New Hampshire 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
$1,905.46 / $1,905.46 / $5,248.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $524.81 / $602.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,445.44 / $4,365.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $489.78 / $1,445.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $2,344.23 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,071.52
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,318.26 / $2,398.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $446.68 / $1,148.15