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Moderate-Complexity Genetic Analysis

North Carolina 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?

$224

Typical negotiated rate. In North Carolina, October 2026.

Insurers have agreed to pay about $224 for this service. The price depends on where it is billed: about $224 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$224$158 to $339
FacilityA hospital or hospital-owned outpatient department$309$148 to $575

How much rates vary

Facilitymedian $309 · 10th to 90th $141 to $851Professionalmedian $224 · 10th to 90th $115 to $457
$100$200$500$1Kfacility $309professional $224

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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
$147.91
Typical High
$309.03
Aetna
Setting
Professional
Modifier
None
Typical Low
$123.03
Median
$147.91
Typical High
$257.04
BCBS North Carolina
Setting
Facility
Modifier
None
Typical Low
$407.38
Median
$489.78
Typical High
$588.84
BCBS North Carolina
Setting
Professional
Modifier
None
Typical Low
$158.49
Median
$338.84
Typical High
$489.78
Cigna
Setting
Facility
Modifier
None
Typical Low
$141.25
Median
$407.38
Typical High
$851.14
Cigna
Setting
Professional
Modifier
None
Typical Low
$85.11
Median
$128.82
Typical High
$281.84
Medcost
Setting
Facility
Modifier
None
Typical Low
$147.91
Median
$147.91
Typical High
$218.78
Medcost
Setting
Professional
Modifier
None
Typical Low
$186.21
Median
$186.21
Typical High
$316.23
United
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$112.20
Typical High
$194.98
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
$72.44
Median
$74.13
Typical High
$112.20
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$28.84
Median
$29.51
Typical High
$44.67
Medcost
Setting
Professional
Modifier
51 · Multiple procedures
Typical Low
$93.33
Median
$93.33
Typical High
$251.19

Where North Carolina 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.

North Carolina· 10th of 51

$224

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.