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North Dakota 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
$524.81 / $707.95 / $1,348.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $676.08 / $891.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,513.56 / $1,698.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,096.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $891.25 / $3,548.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $380.19 / $1,288.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $758.58 / $1,096.48