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CYP2D6 Drug Metabolism Gene Test

Indiana rates for HCPCS 81226

Examines the CYP2D6 gene, which carries the instructions for a liver enzyme that breaks down a large share of common medicines. The test checks for the usual variants, including extra or missing copies of the gene, and reports whether a person clears those drugs slowly, normally, or unusually fast.

Rates data updated October 2026.

How much does CYP2D6 Drug Metabolism Gene Test cost?

$363

Typical negotiated rate. In Indiana, October 2026.

Insurers have agreed to pay about $363 for this service. The price depends on where it is billed: about $269 from a physician practice, and about $447 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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$269$145 to $447
FacilityA hospital or hospital-owned outpatient department$447$407 to $912

How much rates vary

Facilitymedian $447 · 10th to 90th $355 to $1,349Professionalmedian $269 · 10th to 90th $145 to $676
$200$500$1K$2Kfacility $447professional $269

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
$371.54
Median
$676.08
Typical High
$1,659.59
Aetna
Setting
Professional
Modifier
None
Typical Low
$338.84
Median
$371.54
Typical High
$676.08
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$354.81
Median
$446.68
Typical High
$1,348.96
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$676.08
CareSource
Setting
Professional
Modifier
None
Typical Low
$446.68
Median
$501.19
Typical High
$630.96
Cigna
Setting
Facility
Modifier
None
Typical Low
$295.12
Median
$446.68
Typical High
$1,288.25
Cigna
Setting
Professional
Modifier
None
Typical Low
$190.55
Median
$407.38
Typical High
$870.96
Physicians Health Plan of Northern Indiana
Setting
Facility
Modifier
None
Typical Low
$741.31
Median
$912.01
Typical High
$2,187.76
Physicians Health Plan of Northern Indiana
Setting
Professional
Modifier
None
Typical Low
$323.59
Median
$380.19
Typical High
$691.83
United
Setting
Professional
Modifier
None
Typical Low
$190.55
Median
$269.15
Typical High
$537.03
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
$169.82
Median
$186.21
Typical High
$338.84
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$67.61
Median
$74.13
Typical High
$134.90

Where Indiana sits

The same service costs 3.7 times more in Alaska than in Florida. 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.

Indiana· 38th of 51

$363

AK $1,023FL $275

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.