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Genetic Test For A Specific Gene Change

Massachusetts rates for HCPCS 81404

This is a laboratory test that analyzes a particular gene to look for a specific genetic change linked to an inherited condition or a disease risk. Which gene is examined depends on the medical reason the test was ordered, such as a family history of a certain condition or a diagnosis that needs genetic confirmation. The analysis involves techniques of moderate technical complexity compared with simpler single-variant genetic checks.

Rates data updated July 2026.

How much does Genetic Test For A Specific Gene Change cost?

$275

Typical negotiated rate. In Massachusetts, July 2026.

Insurers have agreed to pay about $275 for this service. The price depends on where it is billed: about $275 from a physician practice, and about $550 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 9 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$275$174 to $275
FacilityA hospital or hospital-owned outpatient department$550$380 to $794

How much rates vary

Facilitymedian $550 · 10th to 90th $245 to $871Professionalmedian $275 · 10th to 90th $174 to $631
$100$200$500$1K$2K$5Kfacility $550professional $275

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
$173.78
Median
$478.63
Typical High
$812.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$831.76
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$794.33
Typical High
$1,318.26
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$275.42
Typical High
$812.83
BCBS
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$549.54
Typical High
$794.33
BCBS
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$269.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$338.84
Typical High
$537.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$288.40
Typical High
$724.44
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$3,630.78
Typical High
$9,772.37
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$398.11
Typical High
$467.74
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$457.09
Health New England
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$134.90
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$794.33
Typical High
$1,318.26
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$275.42
Typical High
$812.83
United
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$275.42
Typical High
$331.13
United
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$275.42
Typical High
$549.54

Where Massachusetts sits

The same service costs 3.5 times more in Alaska than in Rhode Island. 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.

Massachusetts· 23rd of 51

$275

AK $617RI $174

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.