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Moderate-Complexity Genetic Analysis

New Jersey 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?

$148

Typical negotiated rate. In New Jersey, July 2026.

Insurers have agreed to pay about $148 for this service. The price depends on where it is billed: about $112 from a physician practice, and about $457 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$112$100 to $151
FacilityA hospital or hospital-owned outpatient department$457$234 to $1,072

How much rates vary

Facilitymedian $457 · 10th to 90th $151 to $3,981Professionalmedian $112 · 10th to 90th $100 to $214
$100$500$2K$10Kfacility $457professional $112

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
$213.80
Median
$457.09
Typical High
$1,148.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$213.80
AmeriHealth
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$489.78
Typical High
$5,623.41
Cigna
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$407.38
Typical High
$851.14
Cigna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$199.53
Typical High
$407.38
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$194.98
Typical High
$302.00
Horizon BCBS
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$10,471.29
Typical High
$23,988.33
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$186.21
United
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$186.21
Typical High
$407.38
United
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$112.20
Typical High
$194.98

Where New Jersey 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.

New Jersey· 46th of 51

$148

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.