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South Carolina 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
$524.81 / $1,862.09 / $3,548.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $602.56 / $831.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $794.33 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $1,905.46 / $4,265.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,071.52
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $676.08 / $1,380.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $758.58 / $891.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $446.68 / $831.76