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Single-Gene Genetic Test

Pennsylvania rates for HCPCS 81249

Examination in a specialist laboratory of the DNA of one gene taken from a patient sample, reported as whether particular changes are present in that gene. The finding supports a diagnosis or a treatment decision rather than answering the question by itself.

Rates data updated July 2026.

How much does Single-Gene Genetic Test cost?

$513

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $513 for this service. The price depends on where it is billed: about $490 from a physician practice, and about $1,148 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 9 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$490$398 to $562
FacilityA hospital or hospital-owned outpatient department$1,148$708 to $1,660

How much rates vary

Facilitymedian $1,148 · 10th to 90th $513 to $2,239Professionalmedian $490 · 10th to 90th $324 to $1,318
$500$1K$2Kfacility $1,148professional $490

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
$512.86
Median
$1,148.15
Typical High
$2,137.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$489.78
Typical High
$2,137.96
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$2,951.21
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$467.74
Typical High
$467.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$977.24
Typical High
$2,041.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$512.86
Typical High
$1,047.13
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$416.87
Median
$416.87
Typical High
$794.33
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$602.56
Typical High
$602.56
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$691.83
Typical High
$1,122.02
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$1,148.15
Typical High
$2,137.96
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$489.78
Typical High
$2,137.96
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$660.69
Typical High
$1,479.11
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$602.56
Typical High
$660.69
United
Setting
Facility
Modifier
Global
Typical Low
$537.03
Median
$602.56
Typical High
$724.44
United
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$363.08
Typical High
$891.25

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· 37th of 51

$513

AK $1,349DE $398

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.