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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 October 2026.

How much does Moderate-Complexity Genetic Analysis cost?

$158

Typical negotiated rate. In Virginia, October 2026.

Insurers have agreed to pay about $158 for this service. The price depends on where it is billed: about $132 from a physician practice, and about $257 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 8 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$132$100 to $174
FacilityA hospital or hospital-owned outpatient department$257$186 to $427

How much rates vary

Facilitymedian $257 · 10th to 90th $186 to $912Professionalmedian $132 · 10th to 90th $74 to $275
$50$200$1K$5Kfacility $257professional $132

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
$138.04
Median
$158.49
Typical High
$426.58
Aetna
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$138.04
Typical High
$165.96
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$186.21
Median
$186.21
Typical High
$912.01
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$74.13
Median
$100.00
Typical High
$134.90
CareFirst
Setting
Professional
Modifier
None
Typical Low
$131.83
Median
$147.91
Typical High
$173.78
Cigna
Setting
Facility
Modifier
None
Typical Low
$190.55
Median
$323.59
Typical High
$467.74
Cigna
Setting
Professional
Modifier
None
Typical Low
$91.20
Median
$138.04
Typical High
$316.23
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$177.83
Median
$204.17
Typical High
$257.04
Medcost
Setting
Facility
Modifier
None
Typical Low
$245.47
Median
$245.47
Typical High
$331.13
Medcost
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$186.21
Typical High
$346.74
Sentara
Setting
Facility
Modifier
None
Typical Low
$131.83
Median
$269.15
Typical High
$10,232.93
Sentara
Setting
Professional
Modifier
None
Typical Low
$158.49
Median
$257.04
Typical High
$10,232.93
United
Setting
Facility
Modifier
None
Typical Low
$223.87
Median
$223.87
Typical High
$223.87
United
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$112.20
Typical High
$257.04
2 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
$69.18
Median
$69.18
Typical High
$79.43
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$27.54
Median
$27.54
Typical High
$31.62

Where Virginia 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.

Virginia· 34th 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.