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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
$525.00 / $1,687.50 / $2,285.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.13 / $525.00 / $555.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,305.00 / $3,562.50 / $3,562.50
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.00 / $450.00 / $1,312.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$492.38 / $536.25 / $1,706.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.93 / $913.97 / $1,142.46
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,082.38 / $1,082.38 / $1,273.39
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.00 / $750.00 / $2,145.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,305.00 / $3,562.50 / $3,562.50
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.00 / $450.00 / $1,312.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.00 / $579.26 / $1,961.33