go back

CYP2C19 Drug Metabolism Gene Test

New York 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?

$275

Typical negotiated rate. In New York, October 2026.

Insurers have agreed to pay about $275 for this service. The price depends on where it is billed: about $275 from a physician practice, and about $355 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 9 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$275$141 to $372
FacilityA hospital or hospital-owned outpatient department$355$234 to $661

How much rates vary

Facilitymedian $355 · 10th to 90th $60 to $759Professionalmedian $275 · 10th to 90th $89 to $617
$20$50$100$200$500$1K$2Kfacility $355professional $275

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$158.49
Median
$245.47
Typical High
$891.25
Aetna
Setting
Professional
Modifier
None
Typical Low
$158.49
Median
$158.49
Typical High
$245.47
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$288.40
Median
$288.40
Typical High
$758.58
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$239.88
Median
$407.38
Typical High
$724.44
CDPHP
Setting
Professional
Modifier
None
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
Cigna
Setting
Facility
Modifier
None
Typical Low
$281.84
Median
$616.60
Typical High
$831.76
Cigna
Setting
Professional
Modifier
None
Typical Low
$177.83
Median
$354.81
Typical High
$1,412.54
Emblem Health
Setting
Facility
Modifier
None
Typical Low
$54.95
Median
$288.40
Typical High
$660.69
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$204.17
Median
$245.47
Typical High
$426.58
Excellus BCBS
Setting
Professional
Modifier
None
Typical Low
$190.55
Median
$288.40
Typical High
$338.84
MVP Health Care
Setting
Facility
Modifier
None
Typical Low
$13.80
Median
$257.04
Typical High
$588.84
MVP Health Care
Setting
Professional
Modifier
None
Typical Low
$89.13
Median
$89.13
Typical High
$602.56
United
Setting
Facility
Modifier
None
Typical Low
$263.03
Median
$288.40
Typical High
$363.08
United
Setting
Professional
Modifier
None
Typical Low
$123.03
Median
$144.54
Typical High
$446.68
Univera
Setting
Facility
Modifier
None
Typical Low
$74.13
Median
$186.21
Typical High
$309.03
Univera
Setting
Professional
Modifier
None
Typical Low
$186.21
Median
$275.42
Typical High
$338.84
2 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
$79.43
Median
$79.43
Typical High
$123.03
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$31.62
Median
$31.62
Typical High
$48.98

Where New York 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.

New York· 27th of 51

$275

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.