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Moderate-Complexity Genetic Analysis

Virginia 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?

$166

Typical negotiated rate. In Virginia, July 2026.

Insurers have agreed to pay about $166 for this service. The price depends on where it is billed: about $138 from a physician practice, and about $214 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 8 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$138$89.13 to $158
FacilityA hospital or hospital-owned outpatient department$214$186 to $407

How much rates vary

Facilitymedian $214 · 10th to 90th $158 to $871Professionalmedian $138 · 10th to 90th $74 to $355
$10.0$100.0$1.0K$10.0Kfacility $214professional $138

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
$158.49
Median
$389.05
Typical High
$794.33
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$158.49
Typical High
$398.11
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$741.31
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$123.03
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$512.86
Typical High
$776.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$380.19
Typical High
$831.76
Cigna
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$114.82
Typical High
$316.23
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$204.17
Typical High
$257.04
Medcost
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$245.47
Typical High
$346.74
Medcost
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$346.74
Typical High
$389.05
Sentara
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$245.47
Typical High
$10,000.00
Sentara
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$245.47
Typical High
$10,000.00
United
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$186.21
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$95.50
Typical High
$213.80

Where Virginia sits

The same service costs 4.2 times more in Alaska than in Vermont. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Virginia $166 · 35th of 51
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.