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Minnesota 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
$707.95 / $707.95 / $707.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $602.56 / $891.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $758.58 / $758.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $758.58 / $758.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $2,884.03 / $6,918.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,096.48 / $1,445.44
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,691.53 / $5,370.32
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,445.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $1,174.90 / $3,548.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $446.68 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $891.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $758.58 / $1,659.59