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Well, if you count space marines as genetically modified, and I'm not sure they really are as they have a lot of implants that alter than physically but start as 'normal' humans, often shaped by natrual selection on hellish worlds, then you have to count the 'gland warriors" too.

https://monster.fandom.com/wiki/Gland_Warrior

The gland warriors seem to be the budget lite version of space marines, beginning as baseline humans that are made into more effective combatants thru implanting biologically engineered enhancement organisms into their bodies.

I'm sure that a lot of the decadent aristocracy seeks this sort of thing out or at least is open to an offer of them, but it's likely the vast majority of them are peddled by those seeking to spread chaos taint thru the imperium's nobility and various agencies are watching out for them vehemently.

Some are likely sold covertly, the salesmen claiming that 'this elixir" will make you smarter, tougher, more capable, etc, while not mentioning it's a retro viral agent that is laced with a virus that will change your dna and likely has some unadvertised side effects.

Ironically the one genetic alteration treatment for humans that is purely, it seems, beneficial and has no bad effects is offered by the Tau to cure victims of genestealer infection. I absolutely know i read somewhere the tau had learned of genestealer infection in their human 'allies' and developed a genetic treatment that essentially deleted the genestealer genetic alteration.

On ogryns, i've heard stories that they were humans who were stranded on harsh, high g worlds during the DAOT and had to evolve to survive, and that in some chaos accelerated their evolution.

Others claim they and squats were genetically modified humans created during the daot along with navigators.