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West 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
$616.60 / $1,122.02 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $602.56 / $870.96
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $1,202.26 / $2,238.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $3,630.78 / $3,630.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $338.84 / $758.58