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Nationwide rates for HCPCS 0263U

Neurology (autism spectrum disorder [ASD]), quantitative measurements of 16 central carbon metabolites (ie, a-ketoglutarate, alanine, lactate, phenylalanine, pyruvate, succinate, carnitine, citrate, fumarate, hypoxanthine, inosine, malate, S-sulfocysteine, taurine, urate, and xanthine), liquid chromatography tandem mass spectrometry (LC-MS/MS), plasma, algorithmic analysis with result reported as negative or positive (with metabolic subtypes of ASD)

Insurance Carrier	Facility/Professional	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $616.87 / $1,061.44 / $2,074.19	Facility	$616.87	$1,061.44	$2,074.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $558.75 / $611.25 / $705.00	Professional	$558.75	$611.25	$705.00
BCBS Facility/Professional Facility Modifier Low / Median / High Price $426.06 / $1,100.63 / $3,180.00	Facility	$426.06	$1,100.63	$3,180.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $336.26 / $336.26 / $672.52	Professional	$336.26	$336.26	$672.52
Cigna Facility/Professional Facility Modifier Low / Median / High Price $502.23 / $1,097.60 / $2,221.78	Facility	$502.23	$1,097.60	$2,221.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $861.93 / $861.93 / $1,077.41	Professional	$861.93	$861.93	$1,077.41
United Facility/Professional Facility Modifier Low / Median / High Price $750.00 / $750.00 / $1,125.00	Facility	$750.00	$750.00	$1,125.00
United Facility/Professional Professional Modifier Low / Median / High Price $315.00 / $450.00 / $900.00	Professional	$315.00	$450.00	$900.00

Nationwide rates for HCPCS 0263U

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