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Oklahoma 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
$562.50 / $750.00 / $1,800.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.00 / $555.00 / $562.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.50 / $487.50 / $2,003.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.93 / $861.93 / $1,077.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $600.00 / $2,512.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $315.00 / $750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $315.00 / $450.00