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Single Gene Analysis

Pennsylvania rates for HCPCS 81204

Reads one particular gene in a sample and reports which versions of it the person carries. Testing focuses on that single gene rather than scanning broadly, so it answers a specific question that has already been narrowed down by symptoms, family history, or earlier testing.

Rates data updated July 2026.

How much does Single Gene Analysis cost?

$117

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $117 for this service. The price depends on where it is billed: about $112 from a physician practice, and about $263 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$112$89.13 to $129
FacilityA hospital or hospital-owned outpatient department$263$166 to $398

How much rates vary

Facilitymedian $263 · 10th to 90th $117 to $562Professionalmedian $112 · 10th to 90th $74 to $302
$100$200$500$1Kfacility $263professional $112

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$263.03
Typical High
$489.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$112.20
Typical High
$489.78
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$676.08
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$223.87
Typical High
$467.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$117.49
Typical High
$239.88
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$177.83
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$165.96
Typical High
$257.04
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$263.03
Typical High
$489.78
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$112.20
Typical High
$489.78
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$426.58
Typical High
$776.25
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$151.36
United
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$138.04
Typical High
$165.96
United
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$81.28
Typical High
$190.55

Where Pennsylvania sits

The same service costs 3.4 times more in Alaska than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Pennsylvania· 33rd of 51

$117

AK $309DE $91.20

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.