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Moderate-Complexity Genetic Analysis

Pennsylvania 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?

$158

Typical negotiated rate. In Pennsylvania, October 2026.

Insurers have agreed to pay about $158 for this service. The price depends on where it is billed: about $151 from a physician practice, and about $251 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 11 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$151$138 to $186
FacilityA hospital or hospital-owned outpatient department$251$186 to $537

How much rates vary

Facilitymedian $251 · 10th to 90th $151 to $1,023Professionalmedian $151 · 10th to 90th $100 to $389
$100$200$500$1K$2K$5Kfacility $251professional $151

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$151.36
Median
$229.09
Typical High
$426.58
Aetna
Setting
Professional
Modifier
None
Typical Low
$112.20
Median
$151.36
Typical High
$194.98
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$72.44
Median
$75.86
Typical High
$79.43
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$29.51
Median
$30.20
Typical High
$31.62
AmeriHealth
Setting
Facility
Modifier
None
Typical Low
$109.65
Median
$218.78
Typical High
$2,041.74
Capital Blue Cross
Setting
Facility
Modifier
None
Typical Low
$724.44
Median
$933.25
Typical High
$5,011.87
Capital Blue Cross
Setting
Professional
Modifier
None
Typical Low
$128.82
Median
$144.54
Typical High
$446.68
Cigna
Setting
Facility
Modifier
None
Typical Low
$181.97
Median
$302.00
Typical High
$562.34
Cigna
Setting
Professional
Modifier
None
Typical Low
$100.00
Median
$199.53
Typical High
$281.84
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$128.82
Median
$239.88
Typical High
$239.88
Geisinger
Setting
Facility
Modifier
None
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Geisinger
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$234.42
Typical High
$407.38
Highmark BCBS
Setting
Facility
Modifier
None
Typical Low
$251.19
Median
$446.68
Typical High
$1,047.13
Independence Blue Cross
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$213.80
Typical High
$2,570.40
Independence Blue Cross
Setting
Professional
Modifier
None
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$151.36
Median
$204.17
Typical High
$537.03
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$151.36
Typical High
$204.17
Martin's Point
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$72.44
Median
$75.86
Typical High
$79.43
Martin's Point
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$29.51
Median
$30.20
Typical High
$31.62
UPMC Health Plan
Setting
Facility
Modifier
None
Typical Low
$186.21
Median
$660.69
Typical High
$1,047.13
UPMC Health Plan
Setting
Professional
Modifier
None
Typical Low
$186.21
Median
$489.78
Typical High
$489.78
United
Setting
Facility
Modifier
None
Typical Low
$165.96
Median
$186.21
Typical High
$223.87
United
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$112.20
Typical High
$223.87

Where Pennsylvania 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.

Pennsylvania· 35th of 51

$158

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.