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Wisconsin 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
$891.25 / $2,041.74 / $2,041.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $616.60 / $891.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $338.84 / $2,344.23
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $524.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $2,398.83 / $3,890.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,122.02 / $2,344.23
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $2,570.40 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $676.08 / $3,548.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $446.68 / $1,348.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $371.54 / $758.58
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,737.80 / $2,454.71
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $3,548.13
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $1,584.89
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,073.80 / $4,073.80 / $4,073.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $891.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $446.68 / $1,445.44