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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 October 2026.

How much does CYP2D6 Drug Metabolism Gene Test cost?

$363

Typical negotiated rate. In Pennsylvania, October 2026.

Insurers have agreed to pay about $363 for this service. The price depends on where it is billed: about $363 from a physician practice, and about $537 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 8 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$363$339 to $447
FacilityA hospital or hospital-owned outpatient department$537$447 to $851

How much rates vary

Facilitymedian $537 · 10th to 90th $363 to $1,349Professionalmedian $363 · 10th to 90th $224 to $676
$200$1K$5K$20Kfacility $537professional $363

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
$363.08
Median
$380.19
Typical High
$1,318.26
Aetna
Setting
Professional
Modifier
None
Typical Low
$331.13
Median
$363.08
Typical High
$380.19
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$177.83
Median
$181.97
Typical High
$190.55
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$70.79
Median
$72.44
Typical High
$75.86
Capital Blue Cross
Setting
Facility
Modifier
None
Typical Low
$4,265.80
Median
$5,011.87
Typical High
$79,432.82
Capital Blue Cross
Setting
Professional
Modifier
None
Typical Low
$316.23
Median
$354.81
Typical High
$1,096.48
Cigna
Setting
Facility
Modifier
None
Typical Low
$446.68
Median
$741.31
Typical High
$1,348.96
Cigna
Setting
Professional
Modifier
None
Typical Low
$213.80
Median
$478.63
Typical High
$691.83
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$316.23
Median
$588.84
Typical High
$588.84
Geisinger
Setting
Facility
Modifier
None
Typical Low
$446.68
Median
$446.68
Typical High
$446.68
Geisinger
Setting
Professional
Modifier
None
Typical Low
$436.52
Median
$676.08
Typical High
$1,148.15
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$363.08
Median
$363.08
Typical High
$1,548.82
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$354.81
Median
$363.08
Typical High
$380.19
Martin's Point
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$177.83
Median
$181.97
Typical High
$190.55
Martin's Point
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$70.79
Median
$72.44
Typical High
$75.86
UPMC Health Plan
Setting
Facility
Modifier
None
Typical Low
$446.68
Median
$501.19
Typical High
$1,122.02
UPMC Health Plan
Setting
Professional
Modifier
None
Typical Low
$446.68
Median
$501.19
Typical High
$501.19
United
Setting
Facility
Modifier
None
Typical Low
$407.38
Median
$446.68
Typical High
$537.03
United
Setting
Professional
Modifier
None
Typical Low
$190.55
Median
$269.15
Typical High
$537.03

Where Pennsylvania 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.

Pennsylvania· 36th 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.