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Kansas 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
$825.41 / $1,549.80 / $2,394.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.50 / $652.50 / $802.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$937.50 / $937.50 / $937.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.00 / $1,228.50 / $1,700.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.93 / $870.55 / $1,094.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $615.00 / $1,372.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $450.00 / $1,275.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.50 / $450.00 / $1,275.00