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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 October 2026.

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

$5,012

Typical negotiated rate. In North Carolina, October 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 $15,136 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$5,012$3,236 to $6,026
FacilityA hospital or hospital-owned outpatient department$15,136$9,772 to $17,378

How much rates vary

Facilitymedian $15,136 · 10th to 90th $7,413 to $22,909Professionalmedian $5,012 · 10th to 90th $2,239 to $7,762
$2K$5K$10K$20Kfacility $15,136professional $5,012

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$8,317.64
Median
$8,317.64
Typical High
$8,317.64
Aetna
Setting
Professional
Modifier
None
Typical Low
$6,606.93
Median
$8,317.64
Typical High
$8,317.64
BCBS North Carolina
Setting
Facility
Modifier
None
Typical Low
$11,220.18
Median
$15,135.61
Typical High
$15,488.17
BCBS North Carolina
Setting
Professional
Modifier
None
Typical Low
$2,238.72
Median
$5,011.87
Typical High
$8,128.31
Cigna
Setting
Facility
Modifier
None
Typical Low
$4,168.69
Median
$13,182.57
Typical High
$22,908.68
Cigna
Setting
Professional
Modifier
None
Typical Low
$2,344.23
Median
$3,467.37
Typical High
$7,762.47
Medcost
Setting
Facility
Modifier
None
Typical Low
$6,025.60
Median
$6,025.60
Typical High
$6,025.60
Medcost
Setting
Professional
Modifier
None
Typical Low
$5,011.87
Median
$5,011.87
Typical High
$8,709.64
United
Setting
Professional
Modifier
None
Typical Low
$2,089.30
Median
$3,019.95
Typical High
$5,128.61
1 more rate 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
Medcost
Setting
Professional
Modifier
51 · Multiple procedures
Typical Low
$2,511.89
Median
$2,511.89
Typical High
$6,918.31

Where North Carolina sits

The same service costs 30.9 times more in Texas than in Alabama. 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· 22nd of 51

$5,012

TX $18,197AL $589

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.