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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
$707.95 / $707.95 / $1,318.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $630.96 / $891.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $524.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $524.81 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $912.01 / $1,148.15
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $1,778.28
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $758.58 / $1,023.29
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $758.58 / $758.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $446.68 / $478.63