go back

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
$495.00 / $495.00 / $530.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$495.00 / $495.00 / $495.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$884.18 / $1,153.63 / $2,249.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.00 / $1,140.00 / $1,230.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.93 / $1,362.39 / $1,702.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $891.00 / $3,562.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.00 / $450.00 / $1,500.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.00 / $1,475.93 / $1,755.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$900.75 / $1,475.93 / $1,755.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.50 / $450.00 / $1,500.00