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Moderate-Complexity Genetic Analysis

Montana 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?

$245

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $245 for this service. The price depends on where it is billed: about $229 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 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$229$100 to $295
FacilityA hospital or hospital-owned outpatient department$288$245 to $562

How much rates vary

Facilitymedian $288 · 10th to 90th $229 to $1,047Professionalmedian $229 · 10th to 90th $95 to $631
$100$1K$10K$100Kfacility $288professional $229

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
$281.84
Median
$389.05
Typical High
$812.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$213.80
Typical High
$1,230.27
BCBS
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$645.65
Typical High
$81,283.05
BCBS
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$245.47
Typical High
$245.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$316.23
Typical High
$1,047.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$269.15
Typical High
$269.15
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$275.42
Typical High
$575.44
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$275.42
Typical High
$575.44
Providence
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$363.08
Typical High
$1,047.13
Providence
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$295.12
United
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
United
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$186.21

Where Montana sits

The same service costs 4.2 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.

Montana· 5th of 51

$245

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.