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North Carolina 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
$600.00 / $600.00 / $1,245.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.00 / $600.00 / $600.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$569.89 / $975.00 / $1,968.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.93 / $861.93 / $1,077.41
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $600.00 / $750.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.50 / $750.00 / $750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.00 / $375.00 / $750.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,305.00 / $3,562.50 / $3,562.50