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Montana 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
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Professional
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$862.50 / $862.50 / $862.50
Cigna
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$1,087.50 / $1,087.50 / $1,087.50
Cigna
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$861.93 / $1,077.41 / $1,087.50
Providence
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$1,087.50 / $1,087.50 / $1,087.50
Providence
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Professional
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$675.00 / $675.00 / $1,087.50
United
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$315.00 / $315.00 / $750.00