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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
$575.44 / $1,513.56 / $3,890.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $575.44 / $724.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $1,348.96 / $2,041.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $630.96 / $1,258.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $575.44 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $912.01 / $1,148.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $616.60 / $3,548.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $758.58 / $891.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $602.56