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Genetic Test For A Specific Gene Change

North Carolina 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?

$245

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $245 for this service. The price depends on where it is billed: about $245 from a physician practice, and about $339 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 6 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$245$219 to $417
FacilityA hospital or hospital-owned outpatient department$339$219 to $813

How much rates vary

Facilitymedian $339 · 10th to 90th $219 to $832Professionalmedian $245 · 10th to 90th $178 to $417
$200$500$1Kfacility $339professional $245

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
$218.78
Median
$416.87
Typical High
$831.76
Aetna
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$218.78
Typical High
$416.87
BCBS
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$831.76
Typical High
$831.76
BCBS
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$380.19
Typical High
$489.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$602.56
Typical High
$1,258.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$128.82
Typical High
$371.54
Medcost
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$245.47
Typical High
$426.58
Medcost
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$630.96
United
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$323.59
Typical High
$363.08
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$165.96
Typical High
$288.40
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$1,318.26
Median
$1,318.26
Typical High
$1,318.26
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$2,041.74

Where North Carolina 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.

North Carolina· 31st of 51

$245

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.