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Tumor Marker Test, Positive or Negative

Massachusetts rates for HCPCS 86294

An antibody-based laboratory test that looks for a tumor-associated substance in a sample and reports the answer as positive or negative, or as a rough level, rather than an exact figure. A common use is checking urine for a bladder cancer marker in someone being monitored after treatment.

Rates data updated July 2026.

How much does Tumor Marker Test, Positive or Negative cost?

$25.70

Typical negotiated rate. In Massachusetts, July 2026.

Insurers have agreed to pay about $25.70 for this service. The price depends on where it is billed: about $25.70 from a physician practice, and about $51.29 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$25.70$22.39 to $30.20
FacilityA hospital or hospital-owned outpatient department$51.29$33.11 to $72.44

How much rates vary

Facilitymedian $51 · 10th to 90th $19 to $89Professionalmedian $26 · 10th to 90th $17 to $55
$10$50$200$1Kfacility $51professional $26

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
$18.62
Median
$52.48
Typical High
$95.50
Aetna
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$18.62
Typical High
$38.90
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$19.05
Median
$29.51
Typical High
$120.23
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$25.70
Typical High
$61.66
BCBS
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$51.29
Typical High
$72.44
BCBS
Setting
Professional
Modifier
Global
Typical Low
$23.99
Median
$23.99
Typical High
$25.12
Cigna
Setting
Facility
Modifier
Global
Typical Low
$17.78
Median
$33.11
Typical High
$53.70
Cigna
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$28.84
Typical High
$44.67
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$34.67
Typical High
$4,897.79
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$33.11
Typical High
$43.65
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$25.70
Typical High
$60.26
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$19.05
Median
$29.51
Typical High
$120.23
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$25.70
Typical High
$61.66
United
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$24.55
Typical High
$30.90
United
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$25.70
Typical High
$58.88

Where Massachusetts sits

The same service costs 2.7 times more in South Dakota 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.

Massachusetts· 26th of 51

$25.70

SD $48.98FL $18.20

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.