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CYP2D6 Drug Metabolism Gene Test

North Carolina 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?

$407

Typical negotiated rate. In North Carolina, October 2026.

Insurers have agreed to pay about $407 for this service. The price depends on where it is billed: about $407 from a physician practice, and about $741 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$407$363 to $468
FacilityA hospital or hospital-owned outpatient department$741$363 to $1,585

How much rates vary

Facilitymedian $741 · 10th to 90th $363 to $2,042Professionalmedian $407 · 10th to 90th $209 to $676
$200$500$1K$2Kfacility $741professional $407

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
$363.08
Median
$363.08
Typical High
$741.31
Aetna
Setting
Professional
Modifier
None
Typical Low
$354.81
Median
$363.08
Typical High
$537.03
BCBS North Carolina
Setting
Facility
Modifier
None
Typical Low
$1,000.00
Median
$1,023.29
Typical High
$1,445.44
BCBS North Carolina
Setting
Professional
Modifier
None
Typical Low
$295.12
Median
$407.38
Typical High
$691.83
Cigna
Setting
Facility
Modifier
None
Typical Low
$338.84
Median
$977.24
Typical High
$2,041.74
Cigna
Setting
Professional
Modifier
None
Typical Low
$208.93
Median
$407.38
Typical High
$602.56
Medcost
Setting
Facility
Modifier
None
Typical Low
$363.08
Median
$363.08
Typical High
$537.03
Medcost
Setting
Professional
Modifier
None
Typical Low
$446.68
Median
$446.68
Typical High
$776.25
United
Setting
Professional
Modifier
None
Typical Low
$190.55
Median
$269.15
Typical High
$467.74
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
$177.83
Median
$181.97
Typical High
$269.15
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$70.79
Median
$72.44
Typical High
$107.15
Medcost
Setting
Professional
Modifier
51 · Multiple procedures
Typical Low
$223.87
Median
$223.87
Typical High
$616.60

Where North Carolina 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.

North Carolina· 32nd of 51

$407

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.