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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 $630.96 / $1,318.26 / $3,388.44	Facility	$630.96	$1,318.26	$3,388.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $602.56 / $831.76	Professional	$489.78	$602.56	$831.76
BCBS Facility/Professional Facility Modifier Low / Median / High Price $676.08 / $1,258.93 / $3,715.35	Facility	$676.08	$1,258.93	$3,715.35
BCBS Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $380.19 / $891.25	Professional	$338.84	$380.19	$891.25
Cigna Facility/Professional Facility Modifier Low / Median / High Price $489.78 / $1,230.27 / $3,162.28	Facility	$489.78	$1,230.27	$3,162.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,096.48 / $1,819.70	Professional	$870.96	$1,096.48	$1,819.70
United Facility/Professional Facility Modifier Low / Median / High Price $338.84 / $758.58 / $891.25	Facility	$338.84	$758.58	$891.25
United Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $446.68 / $870.96	Professional	$316.23	$446.68	$870.96

Nationwide rates for HCPCS 0263U

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