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Hawaii 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)

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Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $741.31 / $891.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $588.84 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $891.25 / $933.25
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $891.25 / $1,122.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $758.58 / $1,122.02