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Tumor Test For Fusion Gene Rearrangements

New York rates for HCPCS 81194

A laboratory test on a tumor sample that looks for rearrangements in a family of related genes that can become abnormally joined to other genes and drive cancer growth. The test covers the whole group of these genes together rather than one at a time. Finding a rearrangement identifies patients who may respond to a specific targeted cancer medicine.

Rates data updated July 2026.

How much does Tumor Test For Fusion Gene Rearrangements cost?

$501

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $501 for this service. The price depends on where it is billed: about $417 from a physician practice, and about $813 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 9 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$417$282 to $617
FacilityA hospital or hospital-owned outpatient department$813$513 to $1,202

How much rates vary

Facilitymedian $813 · 10th to 90th $363 to $1,413Professionalmedian $417 · 10th to 90th $209 to $977
$200$500$1K$2Kfacility $813professional $417

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
$416.87
Median
$891.25
Typical High
$1,412.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$416.87
Typical High
$933.25
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$512.86
Typical High
$1,348.96
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$1,000.00
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$512.86
Typical High
$512.86
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$512.86
Typical High
$512.86
Cigna
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$1,096.48
Typical High
$1,348.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$660.69
Typical High
$1,862.09
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$676.08
Typical High
$1,412.54
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$426.58
Typical High
$977.24
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$316.23
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$489.78
Typical High
$616.60
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$676.08
Typical High
$2,691.53
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$512.86
Typical High
$912.01
United
Setting
Facility
Modifier
Global
Typical Low
$467.74
Median
$512.86
Typical High
$776.25
United
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$436.52
Typical High
$1,122.02
Univera
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$380.19
Typical High
$616.60
Univera
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$489.78
Typical High
$933.25

Where New York sits

The same service costs 3.4 times more in Alaska than in Delaware. 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.

New York· 28th of 51

$501

AK $1,175DE $347

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.