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Whole Genome Sequencing For An Unexplained Condition

North Carolina rates for HCPCS 81425

Reads essentially all of a person's DNA in one test, looking for the change behind an unexplained condition that may have been present from birth or that runs in the family. It goes wider than tests that read only the protein-coding stretches of the genes, which are a separate service. Results take weeks, and findings unrelated to the original question can turn up.

Rates data updated July 2026.

How much does Whole Genome Sequencing For An Unexplained Condition cost?

$5,012

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $5,012 for this service. The price depends on where it is billed: about $5,012 from a physician practice, and about $5,012 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$5,012$3,020 to $6,607
FacilityA hospital or hospital-owned outpatient department$5,012$4,467 to $8,710

How much rates vary

Facilitymedian $5,012 · 10th to 90th $3,162 to $16,596Professionalmedian $5,012 · 10th to 90th $2,239 to $9,120
$0.1$1$10$100$1K$10Kfacility $5,012professional $5,012

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
$3,162.28
Median
$4,466.84
Typical High
$16,595.87
Aetna
Setting
Professional
Modifier
Global
Typical Low
$4,466.84
Median
$6,606.93
Typical High
$16,595.87
BCBS
Setting
Facility
Modifier
Global
Typical Low
$8,511.38
Median
$11,220.18
Typical High
$11,481.54
BCBS
Setting
Professional
Modifier
Global
Typical Low
$2,238.72
Median
$4,570.88
Typical High
$8,128.31
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3,801.89
Median
$10,964.78
Typical High
$22,908.68
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2,344.23
Median
$2,344.23
Typical High
$6,760.83
Medcost
Setting
Facility
Modifier
Global
Typical Low
$4,570.88
Median
$5,754.40
Typical High
$8,709.64
Medcost
Setting
Professional
Modifier
Global
Typical Low
$6,025.60
Median
$6,025.60
Typical High
$6,025.60
United
Setting
Facility
Modifier
Global
Typical Low
$3,019.95
Median
$5,888.44
Typical High
$6,165.95
United
Setting
Professional
Modifier
Global
Typical Low
$2,089.30
Median
$3,019.95
Typical High
$5,370.32
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$23,988.33
Median
$23,988.33
Typical High
$23,988.33
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$25,118.86
Median
$25,118.86
Typical High
$38,018.94

Where North Carolina sits

The same service costs 34.7 times more in Delaware than in Oklahoma. 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· 28th of 51

$5,012

DE $15,136OK $437

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.