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New Hampshire 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
$1,905.46 / $1,905.46 / $5,248.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $524.81 / $758.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,445.44 / $4,365.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $489.78 / $1,445.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $2,344.23 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,071.52
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,318.26 / $2,398.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $446.68 / $1,148.15