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Tennessee 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
$562.34 / $602.56 / $812.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $588.84 / $870.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $758.58 / $758.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $1,548.82 / $2,691.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $912.01 / $1,148.15
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $512.86 / $758.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $446.68 / $758.58