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Genetic Test For A Prognostic Cancer Mutation

Vermont rates for HCPCS 81263

A molecular blood or bone marrow test that looks for a specific genetic mutation acquired within cancer cells themselves, rather than examining the gene-rearrangement pattern shared among a group of cells. It is used in certain blood cancers to help provide information about how the disease is expected to behave and to help guide treatment decisions. Results are interpreted alongside other clinical findings.

Rates data updated July 2026.

How much does Genetic Test For A Prognostic Cancer Mutation cost?

$214

Typical negotiated rate. In Vermont, July 2026.

Insurers have agreed to pay about $214 for this service. The price depends on where it is billed: about $214 from a physician practice, and about $759 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 5 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$214$85.11 to $282
FacilityA hospital or hospital-owned outpatient department$759$490 to $871

How much rates vary

Facilitymedian $759 · 10th to 90th $295 to $871Professionalmedian $214 · 10th to 90th $85 to $282
$100$200$500facility $759professional $214

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$213.80
Typical High
$281.84
BCBS
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$758.58
Typical High
$758.58
Cigna
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$870.96
Typical High
$870.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$426.58
Typical High
$741.31
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$398.11
United
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$398.11
Typical High
$794.33

Where Vermont sits

The same service costs 3.3 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.

Vermont· 50th of 51

$214

AK $661DE $200

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.