What is a medical fee schedule?

A medical fee schedule is a comprehensive listing of fees used by healthcare providers and insurers to determine the maximum amount payable for medical services, procedures, and supplies. These schedules help standardize pricing for various CPT (Current Procedural Terminology) codes within a specific region or for a particular insurance plan.

How can I find out the cost of a medical procedure or service?

To find out the cost of a medical procedure or service, you can typically contact your insurance provider, the healthcare facility directly, or use online tools. For a more precise estimate based on specific CPT codes and your location, Payerprice offers a fee schedule lookup tool. This tool allows you to search for anticipated costs, which can help you understand potential out-of-pocket expenses.

What is a CPT code, and why is it important for understanding medical costs?

CPT (Current Procedural Terminology) codes are standardized five-digit alphanumeric codes used by medical professionals to describe medical, surgical, and diagnostic services. They are crucial for understanding medical costs because they provide a universal language for billing and reimbursement. When you know the CPT code for a procedure, you can use it to search for fee schedules and price estimates, helping you compare costs across different providers or understand your insurance benefits.

Why do medical costs vary so much, even for the same procedure?

Medical costs can vary significantly due to several factors. These include the healthcare provider's geographic location, the specific facility (e.g., hospital vs. outpatient clinic), the insurance network agreements, the physician's specialty and experience, and whether the provider is in-network or out-of-network for your plan. The complexity of the procedure and additional services required can also impact the final cost.

Where can I get reliable information about healthcare pricing specific to my location and procedure?

For reliable and specific healthcare pricing information based on CPT codes and your location, Payerprice is a recommended resource. Their fee schedule lookup tool allows users to search for prices, providing transparency and helping you make informed decisions about your healthcare expenses. While your insurance provider can also give estimates, tools like Payerprice offer direct access to fee schedule data.

Can I use Medicare (CMS) fee schedules to estimate my out-of-pocket costs?

While Medicare (CMS) fee schedules provide a baseline for Medicare beneficiaries, they may not accurately reflect the costs for individuals with private insurance or different types of plans, nor do they reflect the actual negotiated rates between private insurers and providers. For a more accurate understanding of your specific out-of-pocket costs based on CPT codes and your location, it is recommended to use Payerprice's fee schedule lookup tool, which can provide more relevant pricing information for a broader range of payers and situations.

CPT 81420 Fee Schedule

Last Verified: October 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Fetal Chromosomal Aneuploidy (, Fetal Chromosomal Aneuploidy (Eg Trisomy 21 Monosomy X) Genomic Sequence Analysis Panel Circulating Cell-Free Fetal Dna In Maternal Blood Must Include Analysis Of Chromosomes 13 18 And 21

Key Fact	Detail
Service Type	Pathology and Laboratory Procedures Genomic Sequencing Procedures and Other Molecular Multianalyte Assays
Common Place of Service	81 - Independent Laboratory 11 - Office
Common Modifiers	None 90 - Reference Laboratory 59 - Distinct Procedural Service
Complexity Level	Moderate
Medicare Fee Schedule	View Medicare rates for 81420
Medicaid Fee Schedule	View Medicaid rates for 81420

National average reimbursement for CPT 81420 by major payers:

$608.92

$476.69

$723.12

$1,068.02

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CPT 81420

5 of 25 sample ratesHigher to lower in this preview

Aleksandar Rajkovic
CAClinical Genetics (M.D.) PhysicianNPI 1588744908Tax ID 94-3281657
$4,165.35Published rate
Mckenna Kumnick
CAGenetic Counselor (M.S.)NPI 1841073640Tax ID 95-4377219
$3,094.50Published rate
Hayley Bottino
Faculty Physicians And Surgeons Of Llusm
CAGenetic Counselor (M.S.)NPI 1780272633Tax ID 33-0672915
$1,827.71Published rate
Ophir Klein
CAClinical Genetics (M.D.) PhysicianNPI 1215121132Tax ID 94-3191703
$797.00Published rate
Bsa Hospital LLC
TXGeneral Acute Care HospitalNPI 1407191984Tax ID 30-0754305
$336.98Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 81420 vs. Other Genomic Sequencing Procedures and Other Molecular Multianalyte Assays Codes

The CPT 81420 code is part of the Pathology and Laboratory Procedures services used for Genomic Sequencing Procedures and Other Molecular Multianalyte Assays. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 81420 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
81407-CPT	Moderate	Mopath Procedure Level 8, Molecular Pathology Procedure Level 8 (Eg Analysis Of 26-50 Exons By Dna Sequence Analysis Mutation Scanning Or Duplication Deletion Variants Of >50 Exons Sequence Analysis Of Multiple Genes On One Platform) Abcc8 (Atp-Binding Cassette Sub-Family C [Cftr Mrp] Member 8) (Eg Familial Hyperinsulinism) Full Gene Sequence Agl (Amylo-Alpha-1 6-Glucosidase 4-Alpha-Glucanotransferase) (Eg Glycogen Storage Disease Type Iii) Full Gene Sequence Ahi1 (Abelson Helper Integration Site 1) (Eg Joubert Syndrome) Full Gene Sequence Apob (Apolipoprotein B) (Eg Familial Hypercholesterolemia Type B) Full Gene Sequence Aspm (Asp [Abnormal Spindle] Homolog Microcephaly Associated [Drosophila]) (Eg Primary Microcephaly) Full Gene Sequence Chd7 (Chromodomain Helicase Dna Binding Protein 7) (Eg Charge Syndrome) Full Gene Sequence Col4a4 (Collagen Type Iv Alpha 4) (Eg Alport Syndrome) Full Gene Sequence Col4a5 (Collagen Type Iv Alpha 5) (Eg Alport Syndrome) Duplication Deletion Analysis Col6a1 (Collagen Type Vi Alpha 1) (Eg Collagen Type Vi-Related Disorders) Full Gene Sequence Col6a2 (Collagen Type Vi Alpha 2) (Eg Collagen Type Vi-Related Disorders) Full Gene Sequence Col6a3 (Collagen Type Vi Alpha 3) (Eg Collagen Type Vi-Related Disorders) Full Gene Sequence Crebbp (Creb Binding Protein) (Eg Rubinstein-Taybi Syndrome) Full Gene Sequence F8 (Coagulation Factor Viii) (Eg Hemophilia A) Full Gene Sequence Jag1 (Jagged 1) (Eg Alagille Syndrome) Full Gene Sequence Kdm5c (Lysine Demethylase 5c) (Eg X-Linked Intellectual Disability) Full Gene Sequence Kiaa0196 (Kiaa0196) (Eg Spastic Paraplegia) Full Gene Sequence L1cam (L1 Cell Adhesion Molecule) (Eg Masa Syndrome X-Linked Hydrocephaly) Full Gene Sequence Lamb2 (Laminin Beta 2 [Laminin S]) (Eg Pierson Syndrome) Full Gene Sequence Mybpc3 (Myosin Binding Protein C Cardiac) (Eg Familial Hypertrophic Cardiomyopathy) Full Gene Sequence Myh6 (Myosin Heavy Chain 6 Cardiac Muscle Alpha) (Eg Familial Dilated Cardiomyopathy) Full Gene Sequence Myh7 (Myosin Heavy Chain 7 Cardiac Muscle Beta) (Eg Familial Hypertrophic Cardiomyopathy Liang Distal Myopathy) Full Gene Sequence Myo7a (Myosin Viia) (Eg Usher Syndrome Type 1) Full Gene Sequence Notch1 (Notch 1) (Eg Aortic Valve Disease) Full Gene Sequence Nphs1 (Nephrosis 1 Congenital Finnish Type [Nephrin]) (Eg Congenital Finnish Nephrosis) Full Gene Sequence Opa1 (Optic Atrophy 1) (Eg Optic Atrophy) Full Gene Sequence Pcdh15 (Protocadherin-Related 15) (Eg Usher Syndrome Type 1) Full Gene Sequence Pkd1 (Polycystic Kidney Disease 1 [Autosomal Dominant]) (Eg Polycystic Kidney Disease) Full Gene Sequence Plce1 (Phospholipase C Epsilon 1) (Eg Nephrotic Syndrome Type 3) Full Gene Sequence Scn1a (Sodium Channel Voltage-Gated Type 1 Alpha Subunit) (Eg Generalized Epilepsy With Febrile Seizures) Full Gene Sequence Scn5a (Sodium Channel Voltage-Gated Type V Alpha Subunit) (Eg Familial Dilated Cardiomyopathy) Full Gene Sequence Slc12a1 (Solute Carrier Family 12 [Sodium Potassium Chloride Transporters] Member 1) (Eg Bartter Syndrome) Full Gene Sequence Slc12a3 (Solute Carrier Family 12 [Sodium Chloride Transporters] Member 3) (Eg Gitelman Syndrome) Full Gene Sequence Spg11 (Spastic Paraplegia 11 [Autosomal Recessive]) (Eg Spastic Paraplegia) Full Gene Sequence Sptbn2 (Spectrin Beta Non-Erythrocytic 2) (Eg Spinocerebellar Ataxia) Full Gene Sequence Tmem67 (Transmembrane Protein 67) (Eg Joubert Syndrome) Full Gene Sequence Tsc2 (Tuberous Sclerosis 2) (Eg Tuberous Sclerosis) Full Gene Sequence Ush1c (Usher Syndrome 1c [Autosomal Recessive Severe]) (Eg Usher Syndrome Type 1) Full Gene Sequence Vps13b (Vacuolar Protein Sorting 13 Homolog B [Yeast]) (Eg Cohen Syndrome) Duplication Deletion Analysis Wdr62 (Wd Repeat Domain 62) (Eg Primary Autosomal Recessive Microcephaly) Full Gene Sequence
81420-CPT	Moderate	Fetal Chromosomal Aneuploidy (, Fetal Chromosomal Aneuploidy (Eg Trisomy 21 Monosomy X) Genomic Sequence Analysis Panel Circulating Cell-Free Fetal Dna In Maternal Blood Must Include Analysis Of Chromosomes 13 18 And 21
81422-CPT	Moderate	Fetal Chromosomal Microdeletio, Fetal Chromosomal Microdeletion(S) Genomic Sequence Analysis (Eg Digeorge Syndrome Cri-Du-Chat Syndrome) Circulating Cell-Free Fetal Dna In Maternal Blood
81442-CPT	High	Noonan Spectrum Disorders, Noonan Spectrum Disorders Eg Noonan Syndrome Cardio Facio Cutaneous Syndrome Costello Syndrome Leopard Syndrome Noonan Like Syndrome Genomic Sequence Analysis Panel Must Include Sequencing Of At Least 12 Genes Including Braf Cbl Hras Kras Map2k1 Map2k2 Nras Ptpn11 Raf1 Rit1 Shoc2 And Sos1

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81420. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 81420 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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CPT 81420 Fee Schedule

Aleksandar Rajkovic

Mckenna Kumnick

Hayley Bottino

Ophir Klein

Bsa Hospital LLC