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Missouri 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
$637.50 / $1,008.24 / $1,740.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.50 / $652.50 / $727.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.26 / $517.50 / $1,328.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,058.84 / $1,573.16 / $1,787.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.93 / $870.55 / $1,077.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$585.00 / $975.00 / $3,562.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $450.00 / $847.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $450.00 / $900.00