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VKORC1 Warfarin Sensitivity Gene Test

Pennsylvania rates for HCPCS 81355

A genetic test that checks for the common changes in the VKORC1 gene, which affects how strongly a person responds to the blood thinner warfarin. People carrying certain versions need a lower or a higher dose to reach a safe level of blood thinning. A blood or saliva sample is used.

Rates data updated July 2026.

How much does VKORC1 Warfarin Sensitivity Gene Test cost?

$74.13

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $74.13 for this service. The price depends on where it is billed: about $70.79 from a physician practice, and about $135 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$70.79$50.12 to $83.18
FacilityA hospital or hospital-owned outpatient department$135$102 to $224

How much rates vary

Facilitymedian $135 · 10th to 90th $74 to $331Professionalmedian $71 · 10th to 90th $50 to $209
$50$100$200$500facility $135professional $71

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
$74.13
Median
$134.90
Typical High
$316.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$70.79
Typical High
$316.23
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$436.52
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$69.18
Typical High
$69.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$144.54
Typical High
$302.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$93.33
Typical High
$199.53
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$114.82
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$147.91
Typical High
$223.87
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$147.91
Typical High
$302.00
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$70.79
Typical High
$316.23
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$97.72
Typical High
$218.78
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$89.13
Typical High
$89.13
United
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$89.13
Typical High
$104.71
United
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$52.48
Typical High
$131.83

Where Pennsylvania sits

The same service costs 4.0 times more in Alaska than in Vermont. 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· 39th of 51

$74.13

AK $200VT $50.12

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.