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Arizona 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
$683.40 / $1,105.50 / $2,992.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.50 / $502.50 / $502.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.56 / $1,650.44 / $2,744.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.41 / $631.86 / $900.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.00 / $1,218.75 / $2,193.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.93 / $913.97 / $1,142.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $600.00 / $3,562.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $315.00 / $600.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $315.00 / $450.00