go back

Kentucky 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
$616.60 / $1,023.29 / $1,819.70
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
$338.84 / $338.84 / $338.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $338.84 / $354.81
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $13,489.63 / $46,773.51
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,023.29 / $13,803.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $1,202.26 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $3,630.78 / $3,630.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $1,513.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $446.68 / $758.58