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Michigan 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
$712.50 / $712.50 / $1,111.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.00 / $712.50 / $712.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$525.94 / $525.94 / $525.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.64 / $525.94 / $710.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.93 / $913.97 / $1,142.46
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$712.50 / $712.50 / $1,309.22
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.50 / $720.00 / $900.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $450.00 / $477.00