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CYP2C19 Drug Metabolism Gene Test

Wisconsin 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?

$513

Typical negotiated rate. In Wisconsin, October 2026.

Insurers have agreed to pay about $513 for this service. The price depends on where it is billed: about $490 from a physician practice, and about $724 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 11 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$490$288 to $1,047
FacilityA hospital or hospital-owned outpatient department$724$347 to $1,072

How much rates vary

Facilitymedian $724 · 10th to 90th $331 to $1,479Professionalmedian $490 · 10th to 90th $145 to $1,585
$200$500$1K$2Kfacility $724professional $490

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
$346.74
Median
$346.74
Typical High
$346.74
Aetna
Setting
Professional
Modifier
None
Typical Low
$346.74
Median
$346.74
Typical High
$2,290.87
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$630.96
Median
$758.58
Typical High
$794.33
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$630.96
Typical High
$1,548.82
CareSource
Setting
Professional
Modifier
None
Typical Low
$288.40
Median
$288.40
Typical High
$323.59
Cigna
Setting
Facility
Modifier
None
Typical Low
$724.44
Median
$851.14
Typical High
$1,122.02
Cigna
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$794.33
Typical High
$912.01
DeanCare
Setting
Facility
Modifier
None
Typical Low
$346.74
Median
$1,380.38
Typical High
$1,862.09
DeanCare
Setting
Professional
Modifier
None
Typical Low
$1,737.80
Median
$1,737.80
Typical High
$1,949.84
Medica
Setting
Facility
Modifier
None
Typical Low
$223.87
Median
$346.74
Typical High
$588.84
Medica
Setting
Professional
Modifier
None
Typical Low
$169.82
Median
$338.84
Typical High
$1,445.44
Network Health
Setting
Facility
Modifier
None
Typical Low
$331.13
Median
$331.13
Typical High
$446.68
Network Health
Setting
Professional
Modifier
None
Typical Low
$288.40
Median
$467.74
Typical High
$831.76
Prevea360
Setting
Facility
Modifier
None
Typical Low
$223.87
Median
$346.74
Typical High
$588.84
Quartz
Setting
Professional
Modifier
None
Typical Low
$323.59
Median
$691.83
Typical High
$954.99
Quartz
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$147.91
Typical High
$758.58
Security Health
Setting
Professional
Modifier
None
Typical Low
$218.78
Median
$218.78
Typical High
$616.60
Security Health
Setting
Professional
Modifier
None
Typical Low
$218.78
Median
$851.14
Typical High
$2,041.74
United
Setting
Facility
Modifier
None
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
United
Setting
Professional
Modifier
None
Typical Low
$123.03
Median
$186.21
Typical High
$891.25
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
$173.78
Median
$173.78
Typical High
$1,148.15
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$69.18
Median
$69.18
Typical High
$457.09

Where Wisconsin 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.

Wisconsin· 2nd of 51

$513

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.