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Louisiana 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
$794.33 / $1,071.52 / $3,801.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $630.96 / $954.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,479.11 / $2,344.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $588.84 / $5,754.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,071.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $676.08 / $758.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $371.54 / $831.76