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Moderate-Complexity Genetic Analysis

Illinois rates for HCPCS 81403

This genetic test analyzes a specific inherited gene change of moderate testing complexity. It's used when the gene involved doesn't have its own dedicated, individually named test, so a standardized level of testing is used instead based on the complexity of the analysis required. It helps confirm or rule out a specific genetic condition being considered by a doctor or genetic counselor.

Rates data updated July 2026.

How much does Moderate-Complexity Genetic Analysis cost?

$151

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $151 for this service. The price depends on where it is billed: about $148 from a physician practice, and about $288 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$148$100 to $186
FacilityA hospital or hospital-owned outpatient department$288$191 to $380

How much rates vary

Facilitymedian $288 · 10th to 90th $158 to $513Professionalmedian $148 · 10th to 90th $3 to $339
$10.0$100.0$1.0Kfacility $288professional $148

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
$151.36
Median
$288.40
Typical High
$426.58
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$151.36
Typical High
$338.84
BCBS
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$645.65
Typical High
$2,344.23
BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.47
Median
$128.82
Typical High
$141.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$389.05
Typical High
$851.14
Cigna
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$223.87
Typical High
$316.23
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$323.59
Typical High
$831.76
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$239.88
United
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$371.54
United
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$112.20
Typical High
$416.87

Where Illinois sits

The same service costs 4.2 times more in Alaska than in Vermont. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Illinois $151 · 42nd of 51
AK $417VT $100

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.