go back

Utah 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
$676.08 / $3,630.78 / $4,786.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $602.56 / $794.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $660.69 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,071.52
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $3,467.37
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $630.96 / $676.08
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $758.58 / $758.58
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $660.69 / $1,122.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $371.54 / $489.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $602.56