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Maryland 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)

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Aetna
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Professional
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$489.78 / $602.56 / $794.33
CareFirst
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Low / Median / High Price
$537.03 / $602.56 / $691.83
Cigna
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Low / Median / High Price
$870.96 / $870.96 / $1,071.52
Kaiser Permanente
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Professional
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Low / Median / High Price
$707.95 / $794.33 / $1,122.02
United
Facility/Professional
Facility
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Low / Median / High Price
$316.23 / $354.81 / $758.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $354.81 / $724.44
Wellpoint
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Professional
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Low / Median / High Price
$331.13 / $416.87 / $1,122.02