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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
$397.50 / $993.75 / $4,290.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.50 / $492.23 / $637.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$733.13 / $1,107.71 / $2,361.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$822.94 / $861.93 / $1,077.41
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.00 / $375.00 / $450.00
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,950.00 / $6,950.00 / $8,702.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.00 / $600.00 / $600.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.00 / $450.00 / $768.75