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CYP2C19 Drug Metabolism Gene Test

North Carolina rates for HCPCS 81225

A blood or cheek-swab test that examines common variations in the CYP2C19 gene, which controls one of the liver enzymes that break medicines down. The result predicts whether a person clears certain drugs quickly, normally, or slowly, so a prescriber can pick a suitable medicine or adjust the dose. Clopidogrel, several antidepressants, and some acid-reducing medicines depend on this enzyme.

Rates data updated October 2026.

How much does CYP2C19 Drug Metabolism Gene Test cost?

$245

Typical negotiated rate. In North Carolina, October 2026.

Insurers have agreed to pay about $245 for this service. The price depends on where it is billed: about $245 from a physician practice, and about $617 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$245$191 to $302
FacilityA hospital or hospital-owned outpatient department$617$234 to $891

How much rates vary

Facilitymedian $617 · 10th to 90th $234 to $1,318Professionalmedian $245 · 10th to 90th $135 to $447
$200$500$1Kfacility $617professional $245

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$234.42
Median
$234.42
Typical High
$489.78
Aetna
Setting
Professional
Modifier
None
Typical Low
$229.09
Median
$234.42
Typical High
$346.74
BCBS North Carolina
Setting
Facility
Modifier
None
Typical Low
$645.65
Median
$891.25
Typical High
$891.25
BCBS North Carolina
Setting
Professional
Modifier
None
Typical Low
$190.55
Median
$245.47
Typical High
$446.68
Cigna
Setting
Facility
Modifier
None
Typical Low
$223.87
Median
$630.96
Typical High
$1,318.26
Cigna
Setting
Professional
Modifier
None
Typical Low
$134.90
Median
$263.03
Typical High
$389.05
Medcost
Setting
Facility
Modifier
None
Typical Low
$234.42
Median
$234.42
Typical High
$346.74
Medcost
Setting
Professional
Modifier
None
Typical Low
$295.12
Median
$295.12
Typical High
$501.19
United
Setting
Professional
Modifier
None
Typical Low
$123.03
Median
$173.78
Typical High
$302.00
3 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$114.82
Median
$117.49
Typical High
$173.78
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$45.71
Median
$46.77
Typical High
$69.18
Medcost
Setting
Professional
Modifier
51 · Multiple procedures
Typical Low
$144.54
Median
$144.54
Typical High
$398.11

Where North Carolina sits

The same service costs 3.8 times more in Alaska than in Alabama. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

North Carolina· 33rd of 51

$245

AK $661AL $174

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.