go back

Pennsylvania 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 / $1,949.84 / $3,311.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $602.56 / $870.96
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $588.84 / $588.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $1,023.29 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,071.52
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $446.68 / $1,096.48
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $630.96 / $1,288.25
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,905.46 / $3,311.31
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $630.96 / $2,691.53
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $831.76 / $1,122.02
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $831.76 / $1,122.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $758.58 / $891.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $446.68 / $1,122.02