Gene analysis (fragile x mental retardation) abnormal alleles
Medicare pricing data for 50 providers across 9 states
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 (fragile x mental retardation) abnormal alleles (HCPCS code 81243) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $55.85, but hospitals typically charge $67.45 — a 1.2x 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 $55.85, your out-of-pocket cost would be approximately $11.17. 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 1.2x more than what Medicare allows for this procedure. Medicare actually pays $55.85 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Louisiana | $56 | $60 | 1 | 15 | +0.1% |
| Oklahoma | $56 | $87 | 3 | 245 | +0.1% |
| Pennsylvania | $56 | $57 | 3 | 1,103 | +0.1% |
| Arizona | $56 | $75 | 1 | 60 | +0.1% |
| Texas | $56 | $60 | 16 | 6,165 | +0.1% |
| New Jersey | $56 | $71 | 7 | 3,076 | 0.0% |
| Florida | $56 | $71 | 12 | 854 | -0.2% |
| Maryland | $54 | $491 | 3 | 83 | -3.0% |
| Colorado | $52 | $219 | 3 | 17 | -7.8% |
⚠️ 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