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Alaska 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
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,115.50 / $5,175.75 / $8,793.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,512.50 / $2,512.50 / $2,512.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,071.88 / $2,071.88 / $2,071.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.93 / $861.93 / $1,077.41
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $570.00 / $900.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.00 / $750.00 / $3,000.00
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,775.00 / $2,775.00 / $3,000.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.00 / $1,125.00 / $3,000.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $577.50 / $1,462.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.50 / $750.00 / $2,062.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.50 / $1,500.00 / $1,500.00