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Illinois 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
$776.25 / $1,258.93 / $2,238.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $630.96 / $870.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,023.29 / $1,230.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $1,412.54 / $3,467.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $912.01 / $1,148.15
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $977.24 / $1,348.96
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $977.24 / $977.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $758.58 / $1,513.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $446.68 / $758.58