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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
$602.56 / $602.56 / $1,659.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $602.56 / $724.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,659.59 / $2,398.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $676.08 / $758.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $1,174.90 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $912.01 / $1,148.15
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $602.56 / $758.58
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $562.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $758.58 / $891.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $371.54 / $758.58
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13