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Moderate-Complexity Genetic Analysis

Maine 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?

$186

Typical negotiated rate. In Maine, July 2026.

Insurers have agreed to pay about $186 for this service. The price depends on where it is billed: about $186 from a physician practice, and about $245 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 6 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$186$151 to $186
FacilityA hospital or hospital-owned outpatient department$245$186 to $832

How much rates vary

Facilitymedian $245 · 10th to 90th $186 to $1,778Professionalmedian $186 · 10th to 90th $112 to $224
$50.0$100.0$200.0$500.0$1.0K$2.0Kfacility $245professional $186

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
$186.21
Median
$245.47
Typical High
$831.76
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$151.36
Typical High
$204.17
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$1,778.28
Typical High
$1,905.46
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$120.23
Typical High
$263.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$416.87
Typical High
$416.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$186.21
Typical High
$186.21
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$223.87
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$831.76
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$186.21
Typical High
$257.04
United
Setting
Facility
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$1,949.84
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$186.21
Typical High
$302.00

Where Maine 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.

Maine $186 · 26th 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.