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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)

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Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.00 / $705.00 / $705.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.00 / $652.50 / $705.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$727.50 / $750.00 / $750.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.00 / $750.00 / $750.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,927.79 / $2,757.36 / $6,580.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.55 / $1,094.65 / $1,439.61
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,518.73 / $2,500.67 / $5,181.13
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.93 / $861.93 / $1,362.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$750.00 / $1,191.45 / $3,562.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $477.75 / $1,591.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.50 / $750.00 / $1,597.25