go back

New York 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
$616.60 / $1,412.54 / $2,089.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $575.44 / $758.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $338.84 / $977.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $1,202.26 / $2,691.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $3,630.78 / $3,630.78
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $1,230.27 / $2,884.03
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $446.68 / $1,445.44
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $707.95 / $851.14
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,412.54 / $50,118.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $676.08 / $891.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $446.68 / $1,122.02
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $758.58 / $870.96
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $707.95 / $870.96