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Alabama 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
$750.00 / $862.50 / $1,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$862.50 / $862.50 / $862.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $69.98 / $94.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.13 / $486.64 / $562.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.50 / $609.38 / $1,623.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.93 / $861.93 / $1,077.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $315.00 / $450.00