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Connecticut 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
$493.13 / $750.00 / $1,711.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.13 / $493.13 / $525.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.70 / $1,100.63 / $1,856.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.26 / $450.00 / $843.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.50 / $2,412.30 / $4,303.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.93 / $861.93 / $1,077.41
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.00 / $345.00 / $442.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $652.50 / $1,316.18