Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants
Medicare pricing data for 94 providers across 9 states
This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants (HCPCS code 81162) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $1,783, but hospitals typically charge $2,691 — a 1.5x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $1,783, your out-of-pocket cost would be approximately $356.69. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 1.5x more than what Medicare allows for this procedure. Medicare actually pays $1,783 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Maryland | $1,788 | $2,781 | 3 | 78 | +0.3% |
| New York | $1,788 | $5,166 | 3 | 614 | +0.3% |
| Pennsylvania | $1,788 | $1,833 | 4 | 528 | +0.3% |
| Connecticut | $1,788 | $6,242 | 2 | 54 | +0.3% |
| Florida | $1,788 | $2,183 | 25 | 3,428 | +0.3% |
| New Jersey | $1,786 | $2,234 | 13 | 1,392 | +0.1% |
| Illinois | $1,778 | $4,852 | 3 | 474 | -0.3% |
| Texas | $1,766 | $2,036 | 13 | 125 | -1.0% |
| Utah | $1,628 | $4,040 | 1 | 107 | -8.7% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber