Genetic/Molecular Test · 81419

Gene Analysis Panel For Evaluation Of Genes Associated With Epilepsy

What Medicare pays for 81419, what providers bill, and how the price varies across 8 states, drawn from CMS 2023 claims data.

81419 · the short answer

For gene analysis panel for evaluation of genes associated with epilepsy, Medicare pays about $2,399.59 while providers bill $3,241.25 on average, a 1.4× markup, one of the smaller markups in the catalog. State-level Medicare rates range 0% from lowest to highest.

Medicare pays
$2,399.59
Providers bill
$3,241.25
Markup
1.4×
Markup percentile
3th

Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.

Medicare Payment (avg)
$2,399.59
What Medicare actually pays
Billed Charge (avg)
$3,241.25
What providers submit
Markup
1.4x
35% above Medicare rate
6.1K
Total Services
6.1K
Beneficiaries
36
Providers
8
States with Data

Price Range Across States

Lowest State Avg
$2,399.59
Texas
Highest State Avg
$2,399.59
Arizona

What You Might Pay

Est. Commercial Insurance
$5,375.08
Range: $3,762.56 – $7,525.11
Est. Cash / Self-Pay
$2,691.04
Typical self-pay discount

Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.

How we estimate these prices

These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Genetic/Molecular Test procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.

Where this markup sits nationally

Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate

1 more affordable than 3% of 8,901 procedures

1–2: 466 procedures (5%). This entry sits in this band. 2–3: 681 procedures (8%). Above this entry. 3–4: 845 procedures (9%). Above this entry. 4–5: 1,308 procedures (15%). Above this entry. 5–6: 1,725 procedures (19%). Above this entry. 6–7: 1,217 procedures (14%). Above this entry. 7–8: 801 procedures (9%). Above this entry. 8–9: 541 procedures (6%). Above this entry. 9–10: 351 procedures (4%). Above this entry. 10–11: 246 procedures (3%). Above this entry. 11–12: 151 procedures (2%). Above this entry. 12–13: 175 procedures (2%). Above this entry. 13–14: 140 procedures (2%). Above this entry. 14–15: 40 procedures (0%). Above this entry. 15–16: 39 procedures (0%). Above this entry. 16–17: 26 procedures (0%). Above this entry. 17–18: 25 procedures (0%). Above this entry. 18–19: 21 procedures (0%). Above this entry. 19–20: 12 procedures (0%). Above this entry. 20–21: 16 procedures (0%). Above this entry. 21–22: 13 procedures (0%). Above this entry. 22–23: 8 procedures (0%). Above this entry. 23–24: 9 procedures (0%). Above this entry. 24–25: 4 procedures (0%). Above this entry. 25–26: 3 procedures (0%). Above this entry. 26–27: 3 procedures (0%). Above this entry. 27–28: 4 procedures (0%). Above this entry. 28–29: 3 procedures (0%). Above this entry. 29–30: 2 procedures (0%). Above this entry. 30–31: 26 procedures (0%). Above this entry. this procedure 1 31 × markup, bucketed by value

Each bar is a band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.

Source CMS Medicare Physician & Other Practitioners · 2023

Prices by State

State Medicare Payment Billed Charge
Arizona $2,399.59 $3,000.00
Colorado $2,399.59 $4,981.00
Florida $2,399.59 $3,184.69
Louisiana $2,399.59 $2,553.85
Maryland $2,399.59 $4,900.00
New Jersey $2,399.59 $3,671.62
Oklahoma $2,399.59 $3,421.06
Texas $2,399.59 $2,951.57

What the Data Says About Gene Analysis Panel For Evaluation Of Genes Associated With Epilepsy

Across 8 states with reporting providers, CPT code 81419 (Gene Analysis Panel For Evaluation Of Genes Associated With Epilepsy) shows a national average Medicare payment of $2,399.59 against an average billed charge of $3,241.25. That gap, a 1.4x markup, or 35% above the Medicare allowed amount, is among the tightest billed-to-paid spreads we track, this code's chargemaster rate tracks unusually close to the Medicare benchmark.

Genetic/Molecular Test procedures like this one saw 6.1K services billed to Medicare in 2023 by 36 distinct providers, serving 6.1K unique beneficiaries. State-level variation is significant: Texas reports the lowest average payment at $2,399.59, while Arizona reports the highest at $2,399.59. At just 0%, this procedure prices remarkably consistently nationwide, GPCI adjustments barely move the needle for this particular code.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Genetic/Molecular Test category (2.24x), the estimated commercial insurance price lands near $5,375.08, with self-pay cash discounts commonly bringing the figure closer to $2,691.04. Within Genetic/Molecular Test, Gene Analysis Panel For Evaluation Of Genes Associated With Epilepsy ranks #38 of 298 tracked procedures by national average Medicare payment.

What to do with this

If you may have gene analysis panel for evaluation of genes associated with epilepsy done, these steps turn the numbers above into a real-world cost estimate.

  • Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
  • Compare gene analysis panel for evaluation of genes associated with epilepsy costs in your state, Medicare rates vary by locality. Browse states
  • Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
  • Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide

Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.

Frequently Asked Questions

How much does Gene Analysis Panel For Evaluation Of Genes Associated With Epilepsy cost?

Gene Analysis Panel For Evaluation Of Genes Associated With Epilepsy (CPT 81419) is priced fairly consistently nationwide: Medicare pays $2,399.59 on average, and the $2,399.59-$2,399.59 state range stays relatively tight. Providers typically bill $3,241.25.

Why do providers charge more than Medicare pays?

Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.

How much does Gene Analysis Panel For Evaluation Of Genes Associated With Epilepsy cost with insurance?

With commercial insurance, gene analysis panel for evaluation of genes associated with epilepsy costs an estimated $5,375.08 on average (range: $3,762.56-$7,525.11), a moderate premium over Medicare's $2,399.59. Without insurance, the estimated cash price is $2,691.04.

Which state has the lowest cost for Gene Analysis Panel For Evaluation Of Genes Associated With Epilepsy?

Texas and Arizona bookend the range for Gene Analysis Panel For Evaluation Of Genes Associated With Epilepsy, at $2,399.59 and $2,399.59 respectively - a relatively tight $0.00 spread nationwide.

How many providers perform Gene Analysis Panel For Evaluation Of Genes Associated With Epilepsy?

Gene Analysis Panel For Evaluation Of Genes Associated With Epilepsy is comparatively uncommon: only 36 providers nationally billed Medicare for it in 2023, serving 6.1K beneficiaries via 6.1K total services.

What is the billed-to-Medicare markup for Gene Analysis Panel For Evaluation Of Genes Associated With Epilepsy?

Providers bill 1.4x what Medicare pays for Gene Analysis Panel For Evaluation Of Genes Associated With Epilepsy - one of the smaller markups in the catalog at 35% above the Medicare rate.

Related Guides

Negotiating Your Medical Bill

Tips to reduce out-of-pocket costs
Hospital Price Transparency

Your right to upfront pricing
Understanding Medicare Costs

How Medicare payments work
How to Read a Medical Bill

Decode charges and codes
Hospital Markup Explained

Why bills exceed actual costs
Why Costs Vary by State

Geographic pricing factors

Data from CMS Medicare Physician & Other Practitioners (2023).

Read our methodology - how this data is sourced, computed, and verified.

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Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure Editorial

Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.