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CYP2D6 Drug Metabolism Gene Test

Pennsylvania 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 July 2026.

How much does CYP2D6 Drug Metabolism Gene Test cost?

$380

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $380 for this service. The price depends on where it is billed: about $363 from a physician practice, and about $794 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 8 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$363$295 to $427
FacilityA hospital or hospital-owned outpatient department$794$525 to $1,122

How much rates vary

Facilitymedian $794 · 10th to 90th $380 to $1,549Professionalmedian $363 · 10th to 90th $245 to $1,072
$200.0$1.0K$5.0K$20.0Kfacility $794professional $363

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$870.96
Typical High
$1,621.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$363.08
Typical High
$1,621.81
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$354.81
Typical High
$354.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$741.31
Typical High
$1,548.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$436.52
Typical High
$1,023.29
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$588.84
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$446.68
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$691.83
Typical High
$1,148.15
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$870.96
Typical High
$1,548.82
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$363.08
Typical High
$1,621.81
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$776.25
Typical High
$1,122.02
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$501.19
United
Setting
Facility
Modifier
Global
Typical Low
$407.38
Median
$446.68
Typical High
$537.03
United
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$269.15
Typical High
$630.96

Where Pennsylvania sits

The same service costs 3.8 times more in Alaska than in Vermont. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Pennsylvania $380 · 36th of 51
AK $1,023VT $269

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.