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Ohio 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
$707.95 / $1,122.02 / $1,819.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $616.60 / $891.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $416.87 / $954.99
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $870.96
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $11,748.98 / $20,892.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $870.96 / $1,071.52
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $776.25 / $1,584.89
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $1,513.56
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $794.33 / $1,479.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $489.78 / $758.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $446.68 / $758.58