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Massachusetts 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
$524.81 / $1,698.24 / $2,344.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $575.44 / $724.44
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $446.68 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $588.84 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $912.01 / $1,148.15
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,258.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,659.59
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $446.68 / $1,122.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $758.58 / $891.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $575.44 / $1,698.24