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New Jersey 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
$954.99 / $1,000.00 / $4,466.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $602.56 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,659.59 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $912.01 / $1,148.15
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $354.81 / $446.68
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $10,471.29 / $25,703.96
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $489.78 / $602.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $758.58 / $1,548.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $446.68 / $776.25