go back

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
$525.00 / $525.00 / $1,350.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.00 / $525.00 / $705.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,246.83 / $1,511.25 / $1,695.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.93 / $870.55 / $1,094.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$525.00 / $892.50 / $3,562.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $750.00 / $1,275.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $765.00 / $1,087.50