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Moderate-Complexity Genetic Analysis

Massachusetts 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 October 2026.

How much does Moderate-Complexity Genetic Analysis cost?

$195

Typical negotiated rate. In Massachusetts, October 2026.

Insurers have agreed to pay about $195 for this service. The price depends on where it is billed: about $186 from a physician practice, and about $309 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$186$112 to $468
FacilityA hospital or hospital-owned outpatient department$309$245 to $457

How much rates vary

Facilitymedian $309 · 10th to 90th $186 to $603Professionalmedian $186 · 10th to 90th $100 to $933
$100$200$500$1K$2K$5Kfacility $309professional $186

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Aetna
Setting
Professional
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$114.82
AllWays Health Partners
Setting
Facility
Modifier
None
Typical Low
$204.17
Median
$354.81
Typical High
$602.56
AllWays Health Partners
Setting
Professional
Modifier
None
Typical Low
$112.20
Median
$354.81
Typical High
$933.25
BCBS Massachusetts
Setting
Facility
Modifier
None
Typical Low
$295.12
Median
$416.87
Typical High
$588.84
BCBS Massachusetts
Setting
Professional
Modifier
None
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
Cigna
Setting
Facility
Modifier
None
Typical Low
$120.23
Median
$223.87
Typical High
$363.08
Cigna
Setting
Professional
Modifier
None
Typical Low
$112.20
Median
$194.98
Typical High
$724.44
Fallon Health
Setting
Facility
Modifier
None
Typical Low
$83.18
Median
$309.03
Typical High
$5,888.44
Fallon Health
Setting
Professional
Modifier
None
Typical Low
$263.03
Median
$263.03
Typical High
$309.03
Harvard Pilgrim
Setting
Professional
Modifier
None
Typical Low
$112.20
Median
$186.21
Typical High
$537.03
Mass General Brigham
Setting
Facility
Modifier
None
Typical Low
$204.17
Median
$354.81
Typical High
$602.56
Mass General Brigham
Setting
Professional
Modifier
None
Typical Low
$112.20
Median
$354.81
Typical High
$933.25
United
Setting
Facility
Modifier
None
Typical Low
$165.96
Median
$186.21
Typical High
$223.87
United
Setting
Professional
Modifier
None
Typical Low
$74.13
Median
$112.20
Typical High
$354.81
Well Sense
Setting
Facility
Modifier
None
Typical Low
$162.18
Median
$223.87
Typical High
$338.84
Well Sense
Setting
Professional
Modifier
None
Typical Low
$2,511.89
Median
$2,511.89
Typical High
$3,019.95
3 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$50.12
Median
$50.12
Typical High
$50.12
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$19.95
Median
$19.95
Typical High
$19.95
Fallon Health
Setting
Facility
Modifier
QW · Waived lab test
Typical Low
$186.21
Median
$239.88
Typical High
$288.40

Where Massachusetts sits

The same service costs 3.7 times more in Alaska than in Kentucky. 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.

Massachusetts· 21st of 51

$195

AK $417KY $112

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.