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Idaho 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
$1,353.60 / $1,353.60 / $1,950.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.00 / $1,462.50 / $1,462.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$585.00 / $794.63 / $2,925.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.24 / $861.93 / $1,077.41
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.00 / $1,462.50 / $1,550.25
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.00 / $750.00 / $900.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $55.00 / $78.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,125.00 / $1,500.00 / $2,700.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.50 / $1,120.86 / $1,158.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $315.00 / $900.00