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Colorado 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
$758.58 / $2,630.27 / $4,168.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $602.56 / $758.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $2,187.76 / $3,630.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $575.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $489.78 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $870.96 / $1,071.52
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,071.52
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $338.84 / $338.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $549.54