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Moderate-Complexity Genetic Analysis

New York 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 New York, July 2026.

Insurers have agreed to pay about $186 for this service. The price depends on where it is billed: about $148 from a physician practice, and about $331 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 10 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$148$100 to $204
FacilityA hospital or hospital-owned outpatient department$331$195 to $479

How much rates vary

Facilitymedian $331 · 10th to 90th $158 to $562Professionalmedian $148 · 10th to 90th $74 to $339
$100$200$500$1K$2Kfacility $331professional $148

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
$151.36
Median
$331.13
Typical High
$562.34
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$151.36
Typical High
$331.13
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$478.63
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$288.40
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$186.21
Typical High
$186.21
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$186.21
Typical High
$186.21
Cigna
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$398.11
Typical High
$537.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$257.04
Typical High
$891.25
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$398.11
Typical High
$676.08
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$158.49
Typical High
$354.81
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$177.83
Typical High
$331.13
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$208.93
Typical High
$2,089.30
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$257.04
Typical High
$50,118.72
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$331.13
United
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$186.21
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$147.91
Typical High
$436.52
Univera
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$194.98
Typical High
$588.84
Univera
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$177.83
Typical High
$588.84

Where New York 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 York· 25th of 51

$186

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.