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Tumor Test For Fusion Gene Rearrangements

Pennsylvania 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?

$437

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $437 for this service. The price depends on where it is billed: about $417 from a physician practice, and about $1,000 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$339 to $490
FacilityA hospital or hospital-owned outpatient department$1,000$631 to $1,318

How much rates vary

Facilitymedian $1,000 · 10th to 90th $437 to $1,950Professionalmedian $417 · 10th to 90th $282 to $1,148
$200$500$1K$2Kfacility $1,000professional $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
$436.52
Median
$1,000.00
Typical High
$1,548.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$416.87
Typical High
$1,862.09
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$1,862.09
Median
$2,570.40
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$407.38
Typical High
$407.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$851.14
Typical High
$1,778.28
Cigna
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$457.09
Typical High
$933.25
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$363.08
Typical High
$676.08
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$512.86
Typical High
$512.86
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$616.60
Typical High
$977.24
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,096.48
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$1,000.00
Typical High
$1,778.28
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$416.87
Typical High
$1,862.09
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$575.44
Typical High
$1,288.25
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$512.86
Typical High
$575.44
United
Setting
Facility
Modifier
Global
Typical Low
$467.74
Median
$512.86
Typical High
$616.60
United
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$309.03
Typical High
$776.25

Where Pennsylvania 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.

Pennsylvania· 35th of 51

$437

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.