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Test for Rupture of Fetal Membranes

New Hampshire rates for HCPCS 84112

A laboratory test performed on a fluid sample collected from the vagina during pregnancy to check for a specific protein that leaks out when the membranes surrounding the baby have broken. It gives a yes-or-no result and helps confirm or rule out rupture of membranes when the diagnosis is not clear from a physical exam alone. It is used in pregnant patients with symptoms suggestive of their water breaking.

Rates data updated July 2026.

How much does Test for Rupture of Fetal Membranes cost?

$105

Typical negotiated rate. In New Hampshire, July 2026.

Insurers have agreed to pay about $105 for this service. The price depends on where it is billed: about $74.13 from a physician practice, and about $186 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 5 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$74.13$63.10 to $162
FacilityA hospital or hospital-owned outpatient department$186$155 to $389

How much rates vary

Facilitymedian $186 · 10th to 90th $98 to $550Professionalmedian $74 · 10th to 90th $59 to $186
$50$100$200$500facility $186professional $74

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
$74.13
Median
$154.88
Typical High
$426.58
Aetna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$74.13
Typical High
$75.86
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$190.55
Typical High
$562.34
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$63.10
Typical High
$186.21
Cigna
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$371.54
Typical High
$446.68
Cigna
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$93.33
Typical High
$281.84
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$169.82
Typical High
$331.13
United
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$58.88
Typical High
$218.78

Where New Hampshire sits

The same service costs 3.0 times more in South Dakota than in Connecticut. 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 Hampshire· 22nd of 51

$105

SD $186CT $61.66

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.