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Indiana 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
$870.96 / $1,174.90 / $2,754.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $616.60 / $758.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $2,238.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $338.84 / $707.95
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $10,964.78 / $43,651.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $489.78 / $2,951.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $870.96 / $1,071.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $758.58 / $758.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $446.68 / $758.58