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Nebraska 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
$1,513.56 / $1,995.26 / $3,715.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $575.44 / $758.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,148.15 / $2,238.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,148.15 / $1,230.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,445.44 / $1,778.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $891.25 / $3,548.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $446.68 / $831.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $676.08 / $1,122.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $446.68 / $831.76