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Virginia 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 / $1,423.50 / $1,856.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.50 / $615.00 / $637.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,848.50 / $3,652.50 / $4,612.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.26 / $336.26 / $453.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.50 / $2,167.87 / $3,841.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.49 / $861.93 / $1,077.41
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$900.00 / $937.50 / $1,110.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $585.00 / $862.50
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.00 / $750.00 / $1,575.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$525.00 / $870.00 / $3,114.15
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.00 / $870.00 / $3,114.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $375.00 / $562.50