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Tumor Marker Test, Positive or Negative

North Carolina 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?

$20.42

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $20.42 for this service. The price depends on where it is billed: about $20.42 from a physician practice, and about $24.55 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 6 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$20.42$20.42 to $29.51
FacilityA hospital or hospital-owned outpatient department$24.55$20.42 to $53.70

How much rates vary

Facilitymedian $25 · 10th to 90th $17 to $85Professionalmedian $20 · 10th to 90th $14 to $74
$10$20$50$100$200facility $25professional $20

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
$20.42
Median
$22.39
Typical High
$81.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$20.42
Typical High
$74.13
BCBS
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$85.11
Typical High
$85.11
BCBS
Setting
Professional
Modifier
Global
Typical Low
$17.78
Median
$17.78
Typical High
$17.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$17.38
Median
$50.12
Typical High
$117.49
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$17.78
Typical High
$34.67
Medcost
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$33.88
Typical High
$47.86
Medcost
Setting
Facility
Modifier
Global
Typical Low
$16.22
Median
$18.62
Typical High
$38.02
Medcost
Setting
Professional
Modifier
Global
Typical Low
$16.60
Median
$27.54
Typical High
$27.54
United
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$27.54
Typical High
$34.67
United
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$14.13
Typical High
$27.54
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$281.84

Where North Carolina 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.

North Carolina· 45th of 51

$20.42

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.